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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336300748
Report Date: 08/22/2024
Date Signed: 08/22/2024 10:01:46 AM

Document Has Been Signed on 08/22/2024 10:01 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:HERNANDEZ FAMILY CHILD CAREFACILITY NUMBER:
336300748
ADMINISTRATOR/
DIRECTOR:		HERNANDEZ, MARTHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 396-6736
CITY:COACHELLASTATE: CAZIP CODE:
92236
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
08/22/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:41 AM
MET WITH:Martha Hernandez, LicenseeTIME VISIT/
INSPECTION COMPLETED:
10:05 AM
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On 08/22/2024, at 08:41 AM, Licensing Program Analyst (LPA) Jesse Gardner arrived unannounced to the facility to conduct a case management visit to amend a deficiency page, and a LIC9099-C page. LPA met with Licensee Martha Hernandez and conducted a tour of the facility.

On 08/07/2024, a complaint investigation was conducted (10-CC-20240730140514), and as a result of the investigation, a deficiency was determined to be warranted. The facility was cited; however, the regulation for the citation was incorrect. On today's date, the correct regulation was cited. Further, LPA determined the LIC9099-C needed to reflect 13 children in care without an assistant present, as opposed to 14 children as LPA originally noted. Child Two (C2) was over the age requirement to be included in the capacity for the facility.

An exit interview was conducted with Licensee Martha Hernandez, and a copy of this report was reviewed with and provided along with a copy of the Appeal Rights. A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE: DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/22/2024
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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