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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336300927
Report Date: 11/16/2023
Date Signed: 11/16/2023 09:39:12 AM

Document Has Been Signed on 11/16/2023 09:39 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:
336300927
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
11/16/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Daena HernandezTIME COMPLETED:
09:50 AM
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On 11/16/2023, Licensing Program Analyst (LPA) Lorena Valenzuela conducted an unannounced case management visit. Upon arrival to the facility, LPA met with Licensee Daena Hernandez.The purpose of today's visit is to follow up on an individual by the name of Paul Hipolito Zambrano. Mr. Zambrano was identified through Megan's Law and he shows as registered as living at this address.

There are a total of two adults fingerprint cleared and associated to the facility. The Licensee and her partner. Licensee confirmed that this individual does not live at this home, and she is unaware of who the individual is. Licensee stated she has received mail an individual with the same last name on it, so she believes it was a previous tenant. LPA toured the home and all bedrooms and did not observe the individual in the facility.

No further information required at this time.

An exit interview was conducted, and this report was reviewed with the licensee Deana Hernandez. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Lorena Valenzuela
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2023
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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