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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 394500249
Report Date: 05/05/2022
Date Signed: 05/05/2022 12:56:21 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/29/2022 and conducted by Evaluator Erwin Tjhia
COMPLAINT CONTROL NUMBER: 53-CC-20220429084659
FACILITY NAME:ESQUIVEL, MARIA OLIVIAFACILITY NUMBER:
394500249
ADMINISTRATOR:ESQUIVEL, MARIA OLIVIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 712-9167
CITY:LODISTATE: CAZIP CODE:
95240
CAPACITY:14CENSUS: 9DATE:
05/05/2022
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Maria Olivia EsquivelTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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License: Ratio and Capacity
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Erwin Tjhia and Licensing Program Manager (LPM) Bettina Engelman met with licensee, Maria Olivia Esquivel to open the above complaint investigation. LPA toured the facility, observed the care and supervision of children, and conducted interviews.

According to the complaint, licensee is operating out of ratio and capacity requirements. When LPA and LPM arrived for today’s visit, the licensee was alone with 7 children including 1 infant and no school age children. An adult assistant (S1) arrived 30 minutes later. Two 2) more children arrived during the inspection, bringing total to 9 children present today

Report continues on subsequent form 9099-C and 9099-D
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Erwin TjhiaTELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 53-CC-20220429084659
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 OLIVIA
FACILITY NUMBER: 394500249
VISIT DATE: 05/05/2022
NARRATIVE
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Based on LPA and LPM observation and the admission by licensee, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. Title 22 deficiencies were cited and must be corrected by the due date. Failure to correct deficiencies will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected. Appeals rights were discussed.

Notice of Site Visit posted. An exit interview was conducted in which the report was reviewed and discussed with licensee.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Erwin TjhiaTELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 53-CC-20220429084659
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 OLIVIA
FACILITY NUMBER: 394500249
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/05/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/06/2022
Section Cited
CCR
102416.5e
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(e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c).
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Licensee acknowledged that small Family child Care Home ratios must be adhered to, when she has no assistant present. Licensee shall submit a written statement on how to comply with ratio and capacity requirements by POC due date 5/6/22. LPA contact information and capacity sheets were provided.
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This requirement was not met as the evidenced by: licensing staff observed 7 children in the facility (2 infants and 5 preschool children) with licensee and no assistant was present. This presents an immediate risk to the health and safety of children in care.
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LPA will conduct follow up visit to verify compliance,
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Erwin TjhiaTELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3