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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364806517
Report Date: 12/16/2024
Date Signed: 12/16/2024 01:08:39 PM

Document Has Been Signed on 12/16/2024 01:08 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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:HERNANDEZ FAMILY CHILD CAREFACILITY NUMBER:
364806517
ADMINISTRATOR/
DIRECTOR:		HERNANDEZ, ELAINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 885-1511
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92307
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
12/16/2024
TYPE OF VISIT:CollateralUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:56 PM
MET WITH:Elaine HernandezTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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 On 12/16/24 LPA Braddock attempted to conduct an annual inspection at the Hernandez Family Child Care. Licensee informed LPA that she wanted to retire. Licensee states that she have not had children in care since July and that is when she made her decision. Licensee handed LPA her official license and completed a declaration.

A notice of site visit was given to licensee.

Exit interview conducted and report was reviewed with the licensee Elaine Hernandez, along with her appeal rights and Notice of Site Visit.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Sherell Braddock
LICENSING EVALUATOR SIGNATURE: DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2024
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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