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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434405574
Report Date: 10/23/2024
Date Signed: 10/23/2024 05:32:10 PM

Document Has Been Signed on 10/23/2024 05:32 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:HERNANDEZ, MARIAFACILITY NUMBER:
434405574
ADMINISTRATOR/
DIRECTOR:		HERNANDEZ, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 729-4974
CITY:SAN JOSESTATE: CAZIP CODE:
95127
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
10/23/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:16 PM
MET WITH:Maria HernandezTIME VISIT/
INSPECTION COMPLETED:
05:35 PM
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Case Management-Other inspection. LPA met with Licensee Maria Hernandez and explained the reason for the inspection. The purpose of this inspection is to discuss car seat law.

Licensee stated that her spouse transports school-age children who are between the ages of six to nine years old. There is a booster seat for children under LPA provided Licensee with the California Car Seat Law pamphlet and that children 8 years old and under or who is not yet 4"9 needs to use a booster seat. LPA discussed with Licensee that all vehicle occupants must be secured in an appropriate restraint system.

As a result of this inspection, no deficiencies were issued. Exit interview conducted and report was reviewed with Licensee Maria Hernandez. A notice of site visit has been issued and must remain posted for 30 days.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2024
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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