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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364802946
Report Date: 08/15/2019
Date Signed: 08/15/2019 04:55:02 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME:ESPINOZA FAMILY DAY CAREFACILITY NUMBER:
364802946
ADMINISTRATOR:ESPINOZA, OTILIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 951-7313
CITY:VICTORVILLESTATE: CAZIP CODE:
92395
CAPACITY:14CENSUS: 1DATE:
08/15/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
04:46 PM
MET WITH:Otilia Espinoza, LicenseeTIME COMPLETED:
05:00 PM
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Licensing Program Analysts, (LPAs) Hunt and Mabika arrived at the facility to conduct a Case Management Visit. LPAs met with Licensee, Otilia Espinoza to discuss the purpose of the visit, conducted census and toured the facility.

The Department received information from Caregiver Background Check Bureau (CBCB) regarding individual #1, not receiving a criminal record clearance. Licensee states that the individual was never employed at the day-care. LPAs toured the facility and did not observe the individual on the premises.

An exit interview was conducted, notice of site visit posted and a copy of this report was provided to the licensee on this date.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Victoria HuntTELEPHONE: (661) 568-8930
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2019
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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