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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 344501277
Report Date: 11/06/2024
Date Signed: 11/06/2024 10:05:52 AM

Document Has Been Signed on 11/06/2024 10:05 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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:ESMAIL, EZDIHARFACILITY NUMBER:
344501277
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 7DATE:
11/06/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Ezdihar EsmailTIME VISIT/
INSPECTION COMPLETED:
10:15 AM
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On 11/6/2024, Licensing Program Analysts (LPA) Jennie Tedlos conducted a Case Management Inspection for the purpose of making an off limit area in the facility on limits. LPA met with Licensee Ezdihar Esmail. LPA observed 7 children supervised by Licensee.

LPA and Licensee toured the backyard which the Licensee is requesting to be on limits. The backyard has a separate area where livestock is held, 2 sheds, and a play structure. The livestock area and two sheds are off limits to children in care. A workshop area behind shed #1 is blocked off with a temporary fence. Off limit areas of the facility will now be: the garage, all bedrooms, bathroom #1, #2 and master bathroom, the storage room, sheds #1 & #2, and the livestock yard.
On Limit areas are: Dining Room, both Living Rooms, Kitchen, Sunroom/Playroom, the Laundry Room, Bathroom #3, and the Backyard.

In the areas that were evaluated today, no deficiencies were observed. An exit interview was conducted and Notice of Site Visit was posted by LPA and must remain posted for 30 days. A failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Jennie Tedlos
LICENSING EVALUATOR SIGNATURE: DATE: 11/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/06/2024
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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