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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417401
Report Date: 09/10/2024
Date Signed: 09/10/2024 04:17:15 PM

Document Has Been Signed on 09/10/2024 04:17 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:ESQUIVEL, MARIAFACILITY NUMBER:
434417401
ADMINISTRATOR/
DIRECTOR:		MARIAESQUIVELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 665-2995
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
09/10/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:40 PM
MET WITH:Esquivel, MariaTIME VISIT/
INSPECTION COMPLETED:
04:20 PM
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On 9/10/2024, at 2:40 PM, Licensing Program Analyst (LPA) Liridon Fici- Doni arrived unannounced to conduct a case management investigation and was greeted by Esquivel, Maria, Licensee.

During investigation, there were two (2) staff and 12 child present. All are fingerprint cleared and associated to the facility.



Days and hours of operation are Monday - Friday from 7:30 AM to 5:30 PM. LPA reviewed Fire/Disaster drill log during today's inspection was conducted on 5/29/2024. LPA observed a fully charged 3A4BC fire extinguisher last time serviced on 3/11/2024 with working smoke and carbon monoxide detectors.

LPA toured the indoor and outdoor areas of the home during today's inspection. The Licensee’s has a working land line and cell phones in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean, orderly, and safe for the day care children. The backyard is enclosed by a fence, and there are no bodies of water present.

LPA reviewed a selection of five (5) children's file and observed that parent's rights forms, immunization records forms, consents for emergency medical treatment forms, and Identification forms are in each file. LPA observed there is a signed and dated copy of an Individual infant sleep plan (Lic9227) on file and staff is conducting 15-minute sleep logs for an infant in care. LPA observed both Mandated reporting training and first aid/ CPR are current. LPA informed Licensee that Mandated reporting and First aid/CPR is mandatory, and should be renewed every 2 years.

No citations were issued at today's visit.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted with Licensee, and a copy of this review was reviewed and provided.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Liridon Fici
LICENSING EVALUATOR SIGNATURE: DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: ESQUIVEL, MARIA
FACILITY NUMBER: 434417401
VISIT DATE: 09/10/2024
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Licensee has current Pediatric CPR/FIRST AID that was conducted on 3/17/2023. LPA informed Licensee that Mandated reporting and First aid/CPR is mandatory, and should be renewed every 2 years.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Liridon Fici
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024
LIC809 (FAS) - (06/04)
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