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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336300848
Report Date: 08/23/2023
Date Signed: 08/23/2023 01:27:20 PM

Document Has Been Signed on 08/23/2023 01:27 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
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:
08/23/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Jose Hernandez -RomeroTIME COMPLETED:
01:40 PM
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On 08/23/2023, Licensing Program Analyst's (LPA's) Lorena Valenzuela and Jeanette Sanchez arrived at the home to conduct a follow up inspection. LPA's were granted access by Antonia Perez Ledesma and applicant Jose Hernandez- Romero. LPA's advised applicant the reason for the visit was to confirm applicant Jose Hernandez -Romero is a resident of the home. LPA's toured the home and observed bedroom #2 being inhabited by applicant. LPA obtained a copy of the applicant's drivers license which has the home address as his current address.

Applicant Jose Hernandez Romero was reminded that converted garage room is not to be used for children in care, to eat, sleep or watch television and can only be used for children to do activities.

Applicant was advised the application for a small Family Child Care Home will be reviewed with management and submitted for approval with a maximum capacity of 6 or 8 with parent notification.



Exit interview conducted and report was reviewed with the applicant Jose Hernandez Romero.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Lorena Valenzuela
LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2023
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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