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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
274410335
Report Date:
04/27/2023
Date Signed:
04/28/2023 09:19:08 AM
Document Has Been Signed on
04/28/2023 09:19 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
,
2580 N FIRST STREET, STE. 300
SAN JOSE
,
CA
95131
FACILITY NAME:
ORTIZ, ESTHER
FACILITY NUMBER:
274410335
ADMINISTRATOR:
ESTHER ORTIZ
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(831) 754-8721
CITY:
SALINAS
STATE:
CA
ZIP CODE:
93905
CAPACITY:
14
CENSUS:
0
DATE:
04/27/2023
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
08:35 AM
MET WITH:
Esther Ortiz
TIME COMPLETED:
09:05 AM
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Licensing Program Analyst (LPA) met with licensee Esther Ortiz today with the purpose of inspecting the licensee's home. Licensee stated she wanted to close her license instead. Licensee submitted a surrender letter dated today and returned her license. LPA observed there are not children in care. Licensee stated she only takes care of a 3 years old grandchild who resides in the home. Licensee aware that closing her license is permanent and she will need to reapply in the event she wants to obtain a childcare license again.
SUPERVISOR'S NAME:
Mary Segura
TELEPHONE:
(408) 324-2152
LICENSING EVALUATOR NAME:
Fermin Campos-Jaramillo
TELEPHONE:
408-334-8557
LICENSING EVALUATOR SIGNATURE:
DATE:
04/27/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
04/27/2023
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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