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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216379
Report Date: 11/29/2023
Date Signed: 11/29/2023 12:41:13 PM

Document Has Been Signed on 11/29/2023 12:41 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:HERNANDEZ FAMILY CHILD CAREFACILITY NUMBER:
426216379
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 6CENSUS: 6DATE:
11/29/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:58 AM
MET WITH:Jasmin HernandezTIME COMPLETED:
12:55 PM
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On 11-29-23 at 11:58 PM, Licensing Program Analysts (LPAs) German Negrete and Elvin Baddley conducted an unannounced Case Management- Change of Capacity inspection at the abovementioned Family Child Care Home (FCCH). LPAs met with Assistant of the facility Sindela Hipolito and explained the nature/purpose of the inspection. It should be noted Jasmine Hernandez Licensee of the facility arrived ten minutes after LPAs arrival. At the time of the inspection, LPAs observed 6 children are in care.

LPAs, in the company of the Assistant, toured the interior and exterior of the FCCH. LPAs observed the FCCH's interior and exterior to be free of hazardous materials and/or toxins which would pose a danger to the children in care.

LPAs reviewed Licensee’s First Aid/CPR certification (EMSA approved) which was found to be current until 9-4-2024. Furthermore, LPAs reviewed the Licensee’s Mandated Reporter Training certification which was found to be current until 6-13-24. LPAs observed a regulation fire extinguisher which was last serviced on 9-12-23.

The Licensee submitted documentation for a FCCH change of capacity to the Department on 8-28-23. In essence, the Licensee is seeking to change the FCCH’s capacity from eight (Small FCCH) to fourteen (Large FCCH). On 11/21/23, the Department received a fire inspection clearance form from the City of Guadalupe Fire Department for a capacity of fourteen. As such the FCCH's change of capacity to 14 is granted on the present, 11-29-23.

No deficiency cited in todays inspection notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with the Licensee Jasmine Hernandez.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE: DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/29/2023
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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