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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393620664
Report Date: 03/18/2021
Date Signed: 03/18/2021 03:39:02 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:CASA DE ESPERANZA (PS)FACILITY NUMBER:
393620664
ADMINISTRATOR:GREGORIA GONZALEZFACILITY TYPE:
850
ADDRESS:2260 S. NETHERTON AVETELEPHONE:
(209) 636-2761
CITY:STOCKTONSTATE: CAZIP CODE:
95205
CAPACITY:24CENSUS: 7DATE:
03/18/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Selena GudinoTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Fabiola Diaz conducted a case management tele-inspection via video conferencing due to the COVID-19 Pandemic. LPA met with staff Selena Gudino. Present were 7 children.

LPA conducted a tour of the facility to follow-up on an unusual incident report that was self reported by the facility on 3/11/2021. The written unusual incident report was submitted to the Department within 7 days. LPA Diaz requested a current children's roster and a personnel roster with contact information.

There were no deficiencies cited during today's inspection.

Exit interview was conducted. In lieu of a signature due to COVID-19, LPA Diaz requested that staff Selena acknowledge receipt of this report via e-mail. Staff may e-mail a signed copy if able to do so.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 263-2002
LICENSING EVALUATOR NAME: Fabiola DiazTELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2021
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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