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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274417429
Report Date: 08/02/2024
Date Signed: 08/02/2024 11:26:41 AM

Document Has Been Signed on 08/02/2024 11:26 AM - 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:MEDRANO, ESTHERFACILITY NUMBER:
274417429
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 5CENSUS: 5DATE:
08/02/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:40 AM
MET WITH:Esther MedranoTIME VISIT/
INSPECTION COMPLETED:
11:35 AM
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Licensing Program Analyst (LPA) Fermin Campos-Jaramillo conducted an announced case management inspection to the home today. LPA met with licensee Esther Medrano. Licensee was providing care to five children today, including two infants, two preschoolers, and one school age. LPA inspected the home to ensure licensee is operating according with regulations. LPA observed that the licensee has a file for each child enrolled, and a current roster. LPA reviewed with licensee the safe sleep regulations. Licensee stated she started to work on 6/17/24. Technical assistance was provided. Licensee was advised on conduct and document a fire/disaster drill no later than on 12/17/24.

No deficiencies were cited today.

A notice of Site inspection was printed and licensee was instructed to post it for 30 consecutive day.
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE: DATE: 08/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/02/2024
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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