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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274417187
Report Date: 10/10/2024
Date Signed: 10/10/2024 02:41:17 PM

Document Has Been Signed on 10/10/2024 02:41 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:ESPITIA, LAURAFACILITY NUMBER:
274417187
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 6TOTAL ENROLLED CHILDREN: 5CENSUS: 1DATE:
10/10/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:40 PM
MET WITH:Laura EspitiaTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Fermin Campos-Jaramillo conducted an unannounced case management inspection to the home today. LPA met with licensee Laura Espitia. Licensee stated she provides care to 5 children, only one infant was present today. LPA reviewed children's roster and 5 children's files and verified licensee is not missing any forms. Licensee stated she started working with children on 7/15/24. Licensee has conducted and documented a fire drill on 10/07/24. Technical advise was provided to licensee on documenting immunization records and on the correct way to fill up form Lic9227 for infants. LPA reviewed with licensee the safe sleep regulations.

No deficiencies were cited today.

A notice of Site inspection was printed and licensee was instructed to post it for 30 consecutive days
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE: DATE: 10/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/10/2024
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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