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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624759
Report Date: 03/02/2023
Date Signed: 03/02/2023 09:22:08 AM

Document Has Been Signed on 03/02/2023 09:22 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:HERNANDEZ, ANNABELFACILITY NUMBER:
343624759
ADMINISTRATOR:HERNANDEZ, ANNABELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 759-0414
CITY:SACRAMENTOSTATE: CAZIP CODE:
95821
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
03/02/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Annabel HernandezTIME COMPLETED:
09:30 AM
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At 9:00 a.m. on Thursday, March 2nd, 2023, Licensing Program Analyst (LPA) Karyn Guerra met with Applicant, Annabel Hernandez, for the purpose of an announced prelicensing inspection for a change of location. Applicant is previously licensed at facility 343623025 as a large family child care home. Applicant understands that previous license will be closed and care can no longer operate at that location. Applicant has also requested a change in capacity to a small family child care home license. During today's inspection, LPA observed corrections made to the facility including criminal record clearances for all adults in the home and pool fencing. Fence surrounding the pool and hot tub is at least 5 feet tall, is not climbable, and does not obstruct the pool from view. LPA also observed a gate in the pool fencing that swings away from the pool and self latches.

Effective today 03/02/2023 facility is approved for a Small Family Child Care Home license for a capacity of 6 children with no more than 3 infants, or 4 infants only, or up to 8 children with no more than 2 infants, 1 child in Transitional Kindergarten or above and 1 child at least age 6. Infants are children under the age of 2.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Karyn Guerra
LICENSING EVALUATOR SIGNATURE: DATE: 03/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/02/2023
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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