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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343622691
Report Date: 10/19/2023
Date Signed: 10/19/2023 02:20:44 PM

Document Has Been Signed on 10/19/2023 02:20 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:ESMAIL, EZDIHARFACILITY NUMBER:
343622691
ADMINISTRATOR:ESMAIL, EZDIHARFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 624-0366
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
10/19/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Halla EsmailTIME COMPLETED:
02:35 PM
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On 10/19/2023, Licensing Program Analyst (LPA) Jennie Tedlos conducted a Case Management Inspection to verify that the garage inspected by the fire department is not utilized and now off-limits. LPA met with Licensee's Assistant Halla Esmail. LPA observed 11 children supervised by 2 assistants.

LPA and the Assistant toured the home. LPA was shown the garage which was previously used as a day care classroom. After the fire marshal's inspection and conclusion that the garage could not be used, the facility has emptied the garage completely except for a desk. The Assistant explained that for now, the garage is going to be used as an office, but there may be plans in the future to get the proper permits to convert the garage back to a day care classroom. Current off limit areas of the facility will now be: the garage, the second floor, and the storage shed outside.

In the areas that were evaluated today, no deficiencies were observed. An exit interview was conducted and Notice of Site Visit was posted by LPA and must remain posted for 30 days. A failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Jennie Tedlos
LICENSING EVALUATOR SIGNATURE: DATE: 10/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/19/2023
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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