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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500249
Report Date: 07/07/2020
Date Signed: 07/07/2020 03:55:33 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:ESQUIVEL, MARIA OLIVIAFACILITY NUMBER:
394500249
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
07/07/2020
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Maria EsquivelTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Alecia Sifuentes conducted a case management tele-inspection via Facetime with Licensee, Maria Esquivel due to the COVID-19 State of Emergency in lieu of an on-site visit. The purpose of the inspection is for a Change of Location. LPA observed no children in care during the inspection.

A health and safety inspection was conducted inside and out of the home. The facility is a single story home with an unfenced front yard, 3 bedrooms, 2 bathrooms, living room, dining room, kitchen, garage, and fenced backyard. The off-limit areas of the home are library/bedroom #1, master bedroom, garage, and side yard. LPA observed a a shed in the backyard with a lock. LPA observed no bodies of water on the property. Toxins and hazardous items were found inaccessible. The Licensee stated there are no weapons in the home. The fireplace is barricaded and is inaccessible to children.

The Licensee owns the home and provided LPA a copy of homeownership. The Licensee's CPR/First Aid certification expires on 5/15/2022 and CA AB1207 Mandated Reporter certification expires on 6/16/2022. The Licensee provided LPA copies of her immunization's and TB test.

LPA observed a dual functioning smoke and carbon monoxide detector and fire extinguisher which meet the Title 22 regulations. The Licensee was encouraged to visit the departments website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations, and legislation pertaining to family child care homes.

Effective today, 7/7/2020, the Licensee is approved for a small family child care home license to serve a capacity of 6 children with no more than 3 infants or 4 infants only or with a capacity of 8 children with no more than 2 infants, 1 child in kindergarten or elementary school and 1 child at least age 6.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Alecia SifuentesTELEPHONE: (916) 917-9202
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2020
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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