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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500249
Report Date: 01/26/2023
Date Signed: 01/26/2023 03:02:27 PM

Document Has Been Signed on 01/26/2023 03:02 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:ESQUIVEL, MARIA OLIVIAFACILITY NUMBER:
394500249
ADMINISTRATOR:ESQUIVEL, MARIA OLIVIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 712-9167
CITY:LODISTATE: CAZIP CODE:
95240
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
01/26/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Maria Olivia EsquivelTIME COMPLETED:
03:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Tjhia and Licensing Program manager (LPM) Engelman met with the licensee, Maria Olivia Esquivel, to deliver an amended report. Licensing staff toured the facility, observed the care and supervision of the children.

They were 9 children present without any infant and school age children during the visit. There was also an assistant present who was helping with the children in care. This adult assistant, did not have criminal record clearance and/or facility associations, which poses an immediate health, safety or personal rights risk to persons in care.

Deficiencies were cited on the subsequent pages of this report. A Civil Penalty in the amount of $100 was also assessed today.

Title 22 Deficiencies have been cited on the attached LIC 809D. Upon receipt of Type A citations, facility shall post and provide copies of the LIC 809D for parents/guardians of children currently in care and for parents/guardians of newly enrolled children for the next 12 months. Facility must also keep the signed LIC 9224, Acknowledging Receipt of Licensing Reports LIC 809D in each child's files.

This report was reviewed and discussed with licensee. A Notice of Site Visit and appeal rights were provided.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Erwin Tjhia
LICENSING EVALUATOR SIGNATURE: DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/26/2023
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 2
Document Has Been Signed on 01/26/2023 03:02 PM - It Cannot Be Edited


Created By: Erwin Tjhia On 01/26/2023 at 02:14 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: ESQUIVEL, MARIA OLIVIA
FACILITY NUMBER: 394500249

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
01/27/2023
Section Cited
CCR
102416(d)1

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(d) Prior to employment or initial presence in the child care home, all employees and volunteers subject to a criminal record review shall:
(1) Obtain a California clearance or a criminal record exemption as required by law or Department regulations
This requirement is not met as evidenced by:
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The licensee stated that she had sent the uncleared adult assistant for her lifescan yesterday; however, the staff member had a family emergency and could not make it to the appointment. Licensee stated that the staff member will go for fingerprints later today. Licensee stated that her previous assistant left without notice on 1/13/2023

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Based on observation, and interview, the licensee did not comply with the
section cited above by having an adult without
fingerprint clearance at the facility today, helping the children in care, which poses an immediate health, safety or personal rights risk to children in care.
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and that other assistants, who had criminal record clearance, were not available. Licensee stated that she will work with parents to make changes on their children's schedule to comply with Small Family Child Care Home ratios until she has confirmation that her assistant has clearance. Ratio Sheets were provided.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Bettina Engelman
LICENSING EVALUATOR NAME:Erwin Tjhia
LICENSING EVALUATOR SIGNATURE:
DATE: 01/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/26/2023


LIC809 (FAS) - (06/04)
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