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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629865
Report Date: 03/22/2024
Date Signed: 03/22/2024 03:32:09 PM

Document Has Been Signed on 03/22/2024 03:32 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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:HERNANDEZ, JUAN FAMILY CHILD CAREFACILITY NUMBER:
376629865
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
03/22/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Juan HernandezTIME COMPLETED:
04:30 PM
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On 03/22/2024 at 02:00 pm, Licensing Program Analyst (LPA) Dana Stevens conducted an announced pre-licensing inspection with applicant, Juan Hernandez.  Purpose of the inspection is to ensure that the home is in compliance with standards established in CCR, Title 22, Division 12, Chapter 3, for Family Child Care Homes.  This 4 bedroom/2 bath home was toured and inspected. 

Applicant will use the following areas for child care: the living room, dining area, and one bedroom. Off-limit areas are: 3 bedrooms and one bathroom. These areas are made inaccessible to day care children through the use of door knob covers and a safety gate. Applicant will utilize the backyard for outdoor activities and applicant stated total supervision will be provided. The fireplace is screened. There are no bodies of water observed during time of visit. The fire extinguisher is rated 2A 10B:C and is located in the dining area, smoke and carbon monoxide detectors meet requirements and are operational. Children’s toys and play equipment are available. The applicant has a working telephone/cell phone.  Applicant indicated there are no firearms or other weapons in the home.  Hours of Operation are Monday - Friday, 24 hours a day.

Applicant maintains documentation of proof of control of property for review by the Department.  Applicant completed Mandated Reporter AB1207 training and 8 hours of Preventative Health. Pediatric CPR and First Aid certifications expire 01/2026. Required documents were posted.  Applicant and adult residents in the home have criminal record clearances and/or exemptions on file.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Dana Stevens
LICENSING EVALUATOR SIGNATURE: DATE: 03/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/22/2024
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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