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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426211223
Report Date: 11/28/2022
Date Signed: 11/28/2022 02:51:26 PM

Document Has Been Signed on 11/28/2022 02:51 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:ESPARZA FCC AKA JUST FOR KIDSFACILITY NUMBER:
426211223
ADMINISTRATOR:MARTINA ESPARZAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 714-4671
CITY:SANTA MARIASTATE: CAZIP CODE:
93458
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
11/28/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Martina EsparzaTIME COMPLETED:
03:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Martina Jimenez made an ANNUAL require inspection to the home. LPA met with Leticia Esparza, Licensee. There were no children present. Licensee states that she the last day licensee provided care since June, 2021.

A tour of the home was made both inside and outside. Licensee has a 2A10BC fire extinguisher, smoke detector and carbon monoxide detector. Licensee was reminded to service or replace the fire extinguisher yearly.

LPA discussed the requirement for all care providers/employees, including volunteers to obtain immunization against Influenza, Pertussis, and Measles. LPA also discussed the new Mandated Reporter training requirements. LPA provided and reviewed the Care Provider's Guide to Safe Sleep Handout with Licensee.

Licensee requested to be on Inactive Status. Licensee submitted LIC 9211 (Request for Inactive Child Care License Status) to LPA during the visit.

LPA reviewed the handout "A Child Care Provider's Guide to Safe Sleep." LPA provided a Handout for Reporting Child Abuse and Neglect Training provided on line at www.ccld.ca.gov.



The inspection visit was conducted in Spanish and report was translated in Spanish by LPA Jimenez. There were no deficiencies cites at this time. LPA observed licensee post the Notice of Site visit FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE: DATE: 11/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/28/2022
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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