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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415725
Report Date: 11/18/2021
Date Signed: 11/18/2021 04:13:10 PM

Document Has Been Signed on 11/18/2021 04:13 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:ESQUIVEL, MARIAFACILITY NUMBER:
434415725
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
11/18/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:27 PM
MET WITH:Maria EsquivelTIME COMPLETED:
04:20 PM
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Required 1- Year inspection. LPA met with Licensee Maria Esquivel and explained the reason for the inspection. Licensee also requested a change of capacity to a large Family Child Care Home (FCCH). The home has been licensed as a small FCCH since 11/2017 thus the Licensee has over one years of experience that is required to apply for an increase to a Large FCCH. A fire clearance was granted on 11/09/2021. Upon arrival, Licensee and four children were present, whom 1 was infant age. Two school- age children arrived shortly after.

There is board to post required postings. LPA also observed COVID posters posted. There is working phone in the home. The hour of operation are Monday through Friday 7AM to 5PM. Licensee does have a daycare insurance.

LPA toured in the inside and outside of the home. The off-limit areas of the home are all 3 bedrooms, closet, garage, and the left and right side of the yard. LPA reminded Licensee that any disinfectant wipes and hand sanitizers needs to be inaccessible to children. All toys and equipment were observed to be in good condition. There is a fully charged fire extinguisher, smoke detector, and carbon monoxide detector. The last fire disaster drill was conducted on 10/29/2021. Licensee stated that there are no weapons, such as firearms, stored in the home.

The backyard is used and is fenced. There is play structure outside, which is bolted to the ground. LPA observed that the ladder is not anchored to the ground and railing on the ladders is loose. LPA discussed with Licensee about anchoring the ladder and tightening the ladder. There were no bodies of water observed during today's inspection.

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SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 11/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/18/2021
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: ESQUIVEL, MARIA
FACILITY NUMBER: 434415725
VISIT DATE: 11/18/2021
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----------------------CONTINUATION OF 809 DATED 11/18/2021 PAGE 1-----------------------

LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Licensee of the importance of checking recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Licensee does transport children and does have a valid driver's license. Licensee understands that children cannot be left alone and unattended in parked vehicles.

Licensee does not provide Incidental Medical Services (IMS). IMS policy was discussed. For IMS information see Evaluator Manual- Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, an Plan of Providing IMS must be submitted to Licensing. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514- 0301 (voice)/ (800) 514-0383 (TTY) and link to publications: Commonly Asked Questions about Child Care Center and the ADA, available at: http://www.ada.gov/childqanda.htm.

6 children's files were reviewed during today's inspection. The records reviewed include but not limited to immunization records and notification of parents rights. LPA reminded Licensee to ensure that all forms are signed and filled out correctly. LPA observed that C-1 and C-2 had the LIC 627 filled out incorrectly.

Licensee has a valid CPR/1st Aid, which expires on 08/28/2023. Licensee's certificate for the Mandated Reporter training and Preventive Health and Safety are on file. Licensee completed the Mandated Reporter training on 03/2020. LPA reminded Licensee that the Mandated Reporter training needs to be renewed every two years.

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SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: ESQUIVEL, MARIA
FACILITY NUMBER: 434415725
VISIT DATE: 11/18/2021
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----------------CONTINUATION OF 809 DATED 11/18/2021 PAGE 2---------------------------

LPA discussed with Licensee about the maximum capacity requirement of a Large Family Child Care Home License. The maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home shall be either:
(1) 12 children, no more than four of whom may be infants; or
(2) more than 12 and up to 14 children if at least one child is enrolled in and attending kindergarten or elementary school and a second child is at least six years of age and there are no more than three infants being cared for during any time when more than 12 children are being cared for.

When Licensee have more than 12 and up to 14 children in the home, Licensee must notify the parent using the form LIC9150 “Parent Notification Additional Children in Care." LPA reminded Licensee that when Licensee does not have a Helper, Licensee can only care for up to 8 children at any one time in the home.

The adults over 18 and living in the home are Licensee and her two adults children. All adults have cleared criminal record, child abuse index, and TB. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

As a result of this inspection, no deficiencies were cited. Licensee was advised that a license for a large FCCH will be granted and issued upon approval of Licensing Program Manager.

Exit interview conducted and report was reviewed with Licensee Maria Esquivel. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021
LIC809 (FAS) - (06/04)
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