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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274407693
Report Date: 01/18/2024
Date Signed: 09/04/2024 02:23:46 PM

Document Has Been Signed on 09/04/2024 02:23 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:ORTIZ, ESPERANZAFACILITY NUMBER:
274407693
ADMINISTRATOR:ORTIZ, ESPERANZAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 763-2650
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
01/18/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Esperanza OrtizTIME COMPLETED:
02:30 PM
NARRATIVE
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This is an Amended Report.

Licensing Program Analyst (LPA), Teodoro Trujillo, conducted an case management inspection. LPA met with Licensee, Esperanza Ortiz. Present were licensee, her spouse Alfredo, adult resident Delia, licensee 2 year old grandson and adult tenant Keith. No children were in care today.

Day care hours are Monday - Friday from 6:00 AM to 6:00 PM. Licensee has current CPR and First Aid certification with an expiration date of 01/23/2025. Mariana Fernandez Ortiz has current CPR & First Aid 01/23/25. Mandated Reporter Training expires 05/18/2024. Mariana Fernandez Mandated Reporter Training expires 01/19/25.

There are 7 adults living in the home; Licensee, her husband, two adult daughters, sister in law Delia, son in law Jose Luis and daughter's boyfriend, Keith. A review of staff records on January 24, 2024 indicates that all staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA also reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children.

Esperanza's home is recorded thru the assessors office as located at 16430 Charles Schnell Lane, Watsonville. However for mailing purposes the post office recognizes Esperanza's address as 1233 San Miguel Canyon Rd., Watsonville. LPA reviewed completed Child Care Facility Roster during today's visit. LPA inspected the indoor and outdoor areas of the home during today's visit. Home is located in a approximate 3 to 4 acre property.
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE: DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/18/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: ORTIZ, ESPERANZA
FACILITY NUMBER: 274407693
VISIT DATE: 01/18/2024
NARRATIVE
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This is an Amended Report.

There is a 3 bedroom home on the north side of the property, three bedroom home where the child care home is located, and a mobile home on the south side of the property. The north side of the home lives 2 adults and mobile home there are 4 adults living in the home. There are a total of 6 adults living in the north side and south side property.

No deficiencies were cited during today's visit. Exit interview was conducted and report was reviewed with Licensee Esperanza Ortiz.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/04/2024 02:25 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 09/04/2024 12:56 PM


Created By: Teodoro Trujillo On 01/18/2024 at 12:52 PM
Link to Parent Document Below:
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: ORTIZ, ESPERANZA
FACILITY NUMBER: 274407693

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
01/19/2024
Section Cited
CCR
102370(d)(1)

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Deficiency Cleared due to licensee appeal.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Susy Cervantes
LICENSING EVALUATOR NAME:Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE:
DATE: 01/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/18/2024


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