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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500249
Report Date: 05/11/2022
Date Signed: 01/26/2023 03:17:37 PM


Document Has Been Signed on 01/26/2023 03:17 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 01/25/2023 03:59 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

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This is an amend version of a report originally signed on 05/11/2022.


The report was amended on 1/26/2023, because the deficiency cited on 5/5/2022 and the civil penalty assessed on 5/11/2022 were appealed. The citation was incorrectly cited due to a typing error, and therefore it was dismissed, as was the subsequent civil penalty for failure to correct.

On Wednesday, May 11, 2022, Licensing Program Analyst (LPA) Erwin Tjhia and Licensing Program Manager (LPM) Bettina Engelman met with licensee, Maria Olivia Esquivel for Plan of Correction (POC) inspection.

On Tursday, May 5, 2022, facility was cited for ratio/capacity when licensee was caring by herself for 7 children. None of the children present were school-age.

Upon arrival today, LPA observed 4 children, including 2 infants supervised by Licensee Esquivel and her adult assistant. LPA and LPM reviewed children's files and the files had complete records, including signed "Acknowledgement of receipt of Licensing Reports" (LIC 9224) from past deficiencies issued.

The deficiency cited on 05/05/2022 for Ratio and Capacity can be cleared today.


An exit interview was conducted, and Notice of Site Visit was posted by LPA and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Erwin TjhiaTELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 05/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/11/2022
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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