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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500249
Report Date: 12/10/2020
Date Signed: 12/10/2020 12:39:20 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: 4DATE:
12/10/2020
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Maria EsquivelTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Alecia Sifuentes conducted a case management tele-inspection via Facetime with Licensee, Maria Esquivel in lieu of an on-site visit due to the COVID-19. The purpose of the inspection is for a Capacity Change from 8 to 14 children.

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 Fire Safety Inspection Clearance has been received on 12/7/2020 from the Lodi Fire department and the home has been cleared for up to 14 children.

Licensee acknowledges that when there is no assistant present, facility will revert back to the small capacity. Licensee acknowledges that children residing in the home under the age of 10 years shall be included in capacity.

In the areas that were evaluated, no deficiencies were observed at the time of the visit.

Effective today's date, 12/10/2020, LPA will approve the capacity increase to serve up to either 14 children, two (2) of which must be at least 6 years of age and no more than three (3) may be infants; or 12 children, four (4) of which may be infants. Infants are children under the age of 2.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Alecia SifuentesTELEPHONE: (916) 917-9202
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2020
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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