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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336300848
Report Date: 08/07/2023
Date Signed: 08/07/2023 11:23:14 AM

Document Has Been Signed on 08/07/2023 11:23 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-ROMERO FAMILY CHILD CAREFACILITY NUMBER:
336300848
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
08/07/2023
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Jose Fidel Hernandez, Antonia Perez Ledezma TIME COMPLETED:
11:15 AM
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On 08/07/2023, Licensing Program Manager’s (LPMs) Carlos Martinez and Deborah Mullen and Licensing Program Analyst (LPA) Lorena Valenzuela conducted an Office Conference with applicant Jose Hernandez- Romero and Antonia Perez Ledezma. The applicant submitted a family childcare home application on 06/20/2023. On 07/21/2023, LPA Lorena Valenzuela conducted a pre-licensing inspection and there was information obtained which needed to be addressed with applicant.

The following was discussed:

LPM Martinez advised Jose Hernandez Romero of the requirements as applicant/licensee regarding being the primary person providing care and supervision to children in care. Applicant stated he has recently moved into the home and will be living there moving forward.

LPM Martinez advised applicant Jose Hernandez Romero that converted garage area can only be used on a limited basis for activities, for a few hours per day. Applicant understands garage area will not be used for sleeping, eating, or watching television. Applicant provided a written statement attesting to this.

LPA Valenzuela will conduct a follow up visit to verify that applicant is living in the home.

An exit interview was conducted and a copy of this report was provided to applicant Jose Hernandez-Romero.

SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Lorena Valenzuela
LICENSING EVALUATOR SIGNATURE: DATE: 08/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/07/2023
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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