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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493006268
Report Date: 11/05/2019
Date Signed: 11/07/2019 08:07:56 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:ESQUIVEL/MONTES FAMILY CHILD CARE HOMEFACILITY NUMBER:
493006268
ADMINISTRATOR:ESQUIVEL & MONTESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 836-9655
CITY:WINDSORSTATE: CAZIP CODE:
95492
CAPACITY:14CENSUS: 9DATE:
11/05/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:29 AM
MET WITH:Veronica EsquivelTIME COMPLETED:
12:23 PM
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A case management visit was made to the facility by Licensing Program Analyst (LPA) Y. Yang to conduct a well check on the facility and inquire about any unmet needs at the facility due to the 2019 Kincade fire. Multiple attempts were made by the Department to contact the licensee and facility. During today's case management visit, LPA met with licensee Veronica Esquivel. The licensee stated that she currently does not have any unmet needs and is operational. LPA observed nine children being supervised by two staff members at the facility. The licensee stated that the facility did not sustain any structural damages due to the wildfire. This report was read and reviewed with the licensee.


Notice of Site Visit shall be posted for 30 days from today's visit.

There were no Title 22 deficiencies cited during today's inspection
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Yang YangTELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2019
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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