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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376628656
Report Date: 07/29/2021
Date Signed: 07/29/2021 01:08:49 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:ESPARZA, MARIA ELENA FAMILY CHILD CAREFACILITY NUMBER:
376628656
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 2DATE:
07/29/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Maria Esparza TIME COMPLETED:
11:50 AM
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On 7/29/2021 at 11:10 a.m. LPA Casey Gulley conducted an unannounced visit to inspect the off-limits covered patio area located on the side of the house. The covered patio is free of hazards and the garage door is made inaccessible to children through the use of a lock and door knob cover. The playground is surrounded by a fence. Licensee is reminded to supervise children at all times. Licensee updated the facility sketch to reflect the changes made to the covered patio area. There is small outdoor area located in the back of the house that will remain off-limit to children in care.

Effective 7/29/2021, licensee is permitted to use the covered patio area located on the side of the home for outdoor activities.
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Casey GulleyTELEPHONE: (619) 767-2216
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021
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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