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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334845415
Report Date: 04/20/2021
Date Signed: 04/20/2021 08:27:26 PM

Document Has Been Signed on 04/20/2021 08:27 PM - 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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:SERNA FAMILY CHILD CAREFACILITY NUMBER:
334845415
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 2DATE:
04/20/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
05:20 PM
MET WITH:Licensee, Hercilia "Mercedes" SernaTIME COMPLETED:
05:38 PM
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Due to COVID-19 State of Emergency, on 04/20/2021 at 5:30pm, Licensing Program Analyst (LPA) Destinee Hogue conducted a tele-inspection with Licensee, Hercilia "Mercedes" Serna via FaceTime. The purpose of this tele-inspection is to amend a complaint report that was previously issued on 04/14/2021. During today's tele-inspection, LPA Hogue virtually toured the facility inside and outside, took census of daycare children present at the facility, verified facility associations and discussed the purpose of today's tele-inspection with Licensee.

No deficiencies were cited during this tele-inspection.

Due to COVID-19 State of Emergency, LPA Hogue conducted an exit interview with Licensee via FaceTime and provided an email copy of this report. LPA requested the Licensee to acknowledge receipt of the email by replying to the sent email. The electronic response from the Licensee, will serve as the read receipt of the emailed report. Licensee understands that a copy of this report must be made available to the public, upon their request, for the next three years. LPA Hogue issued a Notice of Site Visit and verified it was posted in a prominent location at the facility before ending the tele-inspection. Licensee understands that the Notice of Site Visit must remain posted for the next 30 days.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Destinee Hogue
LICENSING EVALUATOR SIGNATURE: DATE: 04/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/20/2021
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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