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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334842391
Report Date: 05/18/2022
Date Signed: 05/18/2022 08:38:34 AM

Document Has Been Signed on 05/18/2022 08:38 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:HERNANDEZ FAMILY CHILD CAREFACILITY NUMBER:
334842391
ADMINISTRATOR:VERONICA HERNANDEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 835-9478
CITY:INDIOSTATE: CAZIP CODE:
92203
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
05/18/2022
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
08:07 AM
MET WITH:Veronica Hernandez TIME COMPLETED:
08:42 AM
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Licensing Program Analyst (LPA) Jeanette Sanchez arrived at the facility to conduct a case management visit. Licensee is having a pool built in the backyard. At this time, the pool is still under construction but close to completion. A 5ft mesh fence with self latching door has been installed. LPA inspected the fence and found it up to regulation. Licensee is approved to move forward with filling of the pool.

An exit interview was conducted, and this report was reviewed with the licensee Veronica Hernandez. Appeal rights were discussed and provided during the exit interview.

A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Stephanie Hudak
LICENSING EVALUATOR NAME: Jeanette Sanchez
LICENSING EVALUATOR SIGNATURE: DATE: 05/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/18/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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