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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336300776
Report Date: 06/08/2023
Date Signed: 06/08/2023 02:19:28 PM

Document Has Been Signed on 06/08/2023 02:19 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
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:
(760) 641-2481
CITY:COACHELLASTATE: CAZIP CODE:
92236
CAPACITY: 14TOTAL ENROLLED CHILDREN: 3CENSUS: 1DATE:
06/08/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:53 PM
MET WITH:Laura HernandezTIME COMPLETED:
02:17 PM
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On the date and time listed above, Licensing Program Analyst (LPA) Jeanette Sanchez arrived at the facility to conduct a case management visit. LPA met with licensee Laura Hernandez.

LPA toured facility and took census. No health and safety concerns were found.

An exit interview was conducted, and this report was reviewed with the licensee Laura Hernandez. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Jeanette Sanchez
LICENSING EVALUATOR SIGNATURE: DATE: 06/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/08/2023
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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