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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 085407856
Report Date: 06/10/2024
Date Signed: 06/10/2024 03:33:52 PM

Document Has Been Signed on 06/10/2024 03:33 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
CHICO-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:HERNANDEZ, AMY FAMILY CHILD CARE HOMEFACILITY NUMBER:
085407856
ADMINISTRATOR/
DIRECTOR:		HERNANDEZ, AMYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 954-1693
CITY:CRESCENT CITYSTATE: CAZIP CODE:
95531
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
06/10/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:15 PM
MET WITH:Amy HernandezTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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On 6/10/24 at 3:15 PM, Regional Manager (RM) Jordan Monath and Licensing Program Analyst (LPA) Kiriko Lynch made an unannounced visit for the purpose of serving a Temporary Suspension Order (TSO) and Immediate Exclusion Order to Amy Hernandez. The RM explained the nature and purpose of the visit. Amy Hernandez accepted the accusation and Immediate Exclusion Order at 3:30 PM. There were four children in care during today’s visit. A copy of the Child Care Facility Roster was received during the visit.

The following documents were provided to the licensee:

1. Special Instructions Family Day Care Facilities

2. Order for Temporary Suspension of License

3. Accusation and attachments

4. Notice to Respondent and/or Attorney of Record Regarding Statutes, Regulations, Written Directive, and Interim Licensing Standards

5. Confidential Name List

See next page

SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Kiriko Lynch
LICENSING EVALUATOR SIGNATURE: DATE: 06/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/10/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: HERNANDEZ, AMY FAMILY CHILD CARE HOME
FACILITY NUMBER: 085407856
VISIT DATE: 06/10/2024
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6. Statement to Respondent

7. Government Code Sections 11507.5, 11507.6 and 11507.7

8. Instructions For Licensees About the Summary of Charges

9. Summary of Charges for Parent of Children in Care

10. Request for Discovery

11. Notice of Defense (2)

While the order is in effect, the licensee is prohibited from operating the child day care facility. The written notice of the TSO was taped on the outside of the front door and must remain as long as the order is in effect. Licensee was informed that removal of this notice constitutes a violation of the law, a misdemeanor fine of up to $500.00.

The licensee shall post and provide copies of this licensing report to all parents/guardians and must give a copy of the Summary of Charges to the parent or legal guardian of each child receiving services in the facility until the Accusation is either dismissed, or resolved through the administrative process or Stipulated agreement. Each parent/guardian receiving a copy of the Summary of Charges shall sign and date form LIC 9224, Acknowledgement of Receipt of Licensing Reports.

SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Kiriko Lynch
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2024
LIC809 (FAS) - (06/04)
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