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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393620664
Report Date: 06/09/2022
Date Signed: 06/09/2022 03:02:31 PM


Document Has Been Signed on 06/09/2022 03:02 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833



FACILITY NAME:CASA DE ESPERANZAFACILITY NUMBER:
393620664
ADMINISTRATOR:GREGORIA GONZALEZFACILITY TYPE:
850
ADDRESS:2260 S. NETHERTON AVETELEPHONE:
(209) 636-2761
CITY:STOCKTONSTATE: CAZIP CODE:
95205
CAPACITY:24CENSUS: DATE:
06/09/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:site supervisor, Maricela GonzalezTIME COMPLETED:
03:30 PM
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Licensing Program Analysts (LPAs) Lauren Scott met with Site Supervisor, Maricela Gonzalez to follow up on an Unusual Incident Report (UIR) submitted to Community Care Licensing on 05/26/2022. During today's visit the facility was toured. Present were 19 children in care and 3 staff.

Facility evaluation report was reviewed and discussed with Site Supervisor. Exit interview was conducted. A notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

In the areas that were evaluated, no deficiencies were cited during today's inspection
SUPERVISOR'S NAME: Justin L DentonTELEPHONE: (916) -92-9269
LICENSING EVALUATOR NAME: Lauren ScottTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 06/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/09/2022
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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