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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336300776
Report Date: 05/17/2023
Date Signed: 05/17/2023 10:28:26 AM

Document Has Been Signed on 05/17/2023 10:28 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
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:HERNANDEZ FAMILY CHILD CAREFACILITY NUMBER:
336300776
ADMINISTRATOR:HERNANDEZ, LAURAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(442) 477-1838
CITY:COACHELLASTATE: CAZIP CODE:
92236
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
05/17/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:43 AM
MET WITH:Laura HernandezTIME COMPLETED:
10:33 AM
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On 5/172023, Licensing Program Analyst (LPA) Jeanette Sanchez arrived at the facility for a case management - POC inspection. LPA toured the facility.

Licensee provided LPA with copy of liability insurance and lease agreement. Licensee is scheduled for lead training on 6/3/2023. Cactus plants are surrounded by mesh. Kitchen cabinets and all doors have been made inaccessible with latches. Garage door has been locked. Poisons/toxins have been stored in garage.

Application for Large Family Child Care Home will be submitted for provisional approval with a maximum capacity of 12, or 14 with parent notification. If health and safety (with lead) training certificate is not received by June 16th, the provisional license may be revoked.

Exit interview conducted and report was reviewed with the applicant Laura Hernandez.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Jeanette Sanchez
LICENSING EVALUATOR SIGNATURE: DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/17/2023
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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