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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 085407856
Report Date: 06/17/2022
Date Signed: 06/17/2022 12:00:58 PM

Document Has Been Signed on 06/17/2022 12:00 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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:HERNANDEZ, AMY FAMILY CHILD CARE HOMEFACILITY NUMBER:
085407856
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
06/17/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Amy HernandezTIME COMPLETED:
12:15 PM
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A Case Management - Licensee Initiated inspection was conducted at the facility by Licensing Program Analyst (LPA) Kiriko Lynch in response to an capacity increase Family Child Care Home (FCCH) application received by the Department on 03/10/2022. During today's visit, the facility was operating within the licensed capacity and ratio requirements. The facility was toured and inspected. No deficiencies were observed. Fire clearance was granted and received by Licensing on 06/13/2022.

License for the Large FCCH for a capacity of 14 children is approved today, 06/17/2022.
SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Kiriko Lynch
LICENSING EVALUATOR SIGNATURE: DATE: 06/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/17/2022
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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