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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623750
Report Date: 08/30/2021
Date Signed: 08/30/2021 10:01:40 AM

Document Has Been Signed on 08/30/2021 10:01 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:MENDOZA, ESMERALDAFACILITY NUMBER:
343623750
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
08/30/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Esmeralda MendozaTIME COMPLETED:
10:15 AM
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On August 30th, 2021 at 9:00 AM, Licensing Program Analyst (LPA) Tanya Washington met with Licensee, Esmeralda Mendoza for an unannounced case management inspection to increase capacity to the maximum number of 14 children. Upon arrival, LPA observed care and supervision of four children supervised by the Licensee. Facility hours and days of operation are Monday- Friday, from 7 AM to 5:30 PM.

During today's inspection, Licensee and LPA toured all areas of the home accessible to children in care. Off limit areas of the home include: all three bedrooms, including master bathroom and garage. Licensee understands that children may never enter off limit areas of the home.

LPA discussed capacity options with and without an assistant. Licensee understands that when her or the assistant are left alone with a group of children, the ratios divert to small license requirements.

On July 27, 2021, Sacramento County Department of Community Development has granted a fire clearance for this facility with a condition of no use of garage.

Fire extinguisher (2A10BC), carbon monoxide and smoke detector meet regulation. Toys appear to be safe. The backyard is fenced. The Licensee understands that in unfenced area’s 100% supervision of children is required. There are no bodies of water on the premises. Per licensee there are no firearms in the home. Licensee understands that prior to making alterations or additions to the home or grounds, the licensee shall notify the Department of the proposed changes.

EFFECTIVE TODAY, 08/30/2021 THE FACILITY IS LICENSED TO SERVE A MAX. CAP OF 12 (WHEN THERE IS AN ASSISTANT PRESENT): WITH NO MORE THAN 4 INFANTS.
OR MAX CAP 14 - NO MORE THAN 3 INFANTS. 1 CHILD IN KINDERGARTEN OR ELEMENTARY SCHOOL AND 1 CHILD AT LEAST AGE 6.
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Tanya Washington
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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