<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004992
Report Date: 01/24/2025
Date Signed: 01/24/2025 01:35:45 PM

Document Has Been Signed on 01/24/2025 01:35 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:ESPINOZA CARE HOMEFACILITY NUMBER:
347004992
ADMINISTRATOR/
DIRECTOR:		ESPINOZA, ALFREDOFACILITY TYPE:
735
ADDRESS:5440 LIBERTY STREETTELEPHONE:
(916) 550-8053
CITY:NORTH HIGHLANDSSTATE: CAZIP CODE:
95660
CAPACITY: 4CENSUS: 3DATE:
01/24/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Alfredo EspinozaTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On January 24, 2025, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to conduct a required annual inspection utilizing the care tool. LPA met with direct support professional who then contacted Administrator who arrived to the facility shortly afterwards.

LPA and Administrator conducted a tour of the facility, areas toured included but not limited to: three private clients room, two bathroom, two staff room, garage, kitchen and the common areas. LPA observed no clients in the facility as they are at day program. LPA observed facility to be at a comfortable temperature of 75*. LPA observed sharps, toxins, and medications to be locked and inaccessible to clients. LPA observed facility to have two days of perishable and seven days of nonperishable foods. LPA observed facility having ample supply of linens. LPA observed facility to be clean, sanitary and free of malodor.

LPA observed fire extinguisher recently serviced on December 5, 2024. Fire Drills conducted monthly for year of 2024. LPA reviewed Facility Emergency Disaster Plan to be recently reviewed by Administrator on January 5, 2025.

File review conducted and files are complete.

LPA obtained a copy of LIC 500, LIC 308, and surety bond.

No deficiencies cited.

Exit interview conducted and a copy was provided.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/24/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1