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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500486
Report Date: 08/30/2021
Date Signed: 08/30/2021 12:50:42 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:MAGDALENO, ESTHERFACILITY NUMBER:
394500486
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
08/30/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Esther Magdaleno TIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Alecia Sifuentes met with Licensee, Esther Magdaleno for a Change of Location inspection. Facility address listed above report is incorrect. The correct facility address is 1970 Roualt Way, Lodi CA 95242. Off limits areas include the master bedroom, pantry entry, first bathroom, son and daughter's bedroom. This is a single story home with five bedrooms and three and a half bathrooms.

LPA observed all areas of the home. LPA observed no bodies of water on the property. Toxins and dangerous items were found inaccessible. Licensee stated fireplace is barricaded and will remain inaccessible to children. A copy of the mortgage statement is in the facility file.

Licensee stated there are no weapons in the home. Licensee’s CPR/First Aid certification expires 6/7/2022. All adults in the home have criminal record clearances.

LPA tested the smoke alarm and carbon monoxide detectors and fire extinguisher meet Title 22 regulations. LPA reviewed licensing forms and provided the licensing website, www.ccld.ca.gov, so applicant may download forms, or review regulations.

Effective today, 8/30/2021, LPA is granting a small family child care home to serve a capacity of 6 children with no more than 3 infants or 4 infants only. Or with a capacity of 8 children: 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: 08/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2021
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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