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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426211223
Report Date: 11/27/2023
Date Signed: 11/27/2023 03:52:52 PM

Document Has Been Signed on 11/27/2023 03:52 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: 14CENSUS: 1DATE:
11/27/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Jackie DiazTIME COMPLETED:
04:05 PM
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On 11/27/2023 at 2:30 PM, Licensing Program Analyst (LPA), Martina Jimenez, conducted a case management - other inspection for the purpose of revising and updating amended reports. LPA met with Jackie Esparza, licensee's adult daughter. Licensee's daughter was advised the purpose of this inspection. LPA observe one (1) child at the time of the inspection.

The Licensee's daughter was provided amended reports that were issued on 11/16/2023. LPA requested the reports previously issued to the licensee. The previous reports was not available at the time of the inspection. Licensee's daughter stated licensee would mail the report issued on 11/16/2023, to CCLD by 12/4/ 2023.

The In addition, LPA informed licensee's daughter that changes in the Community Care Licensing Division transparency page may take up to one week to reflect changes.

During today's inspection no deficiency as cited. Exit interview and report was reviewed with Jackie Esparza, licensee's adult daughter. Notice of site visit was provided and must remain posted for the next 30 days.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE: DATE: 11/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/27/2023
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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