274417843-11-20-2025-07-CC-MJVA-DNLV7B-20251120151052

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274417843
Report Date: 11/20/2025
Date Signed: 11/20/2025 03:11:03 PM

Document Has Been Signed on 11/20/2025 03:11 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:	ESPINOZA GUZMAN, EVANGELINA		FACILITY NUMBER:	274417843
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 3	DATE:	11/20/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:00 PM
MET WITH:	Evangelina Espinoza Guzman		TIME VISIT/ INSPECTION COMPLETED:	03:20 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On November 20, Licensing Program Analyst (LPA) Martha Jimenez-Villanueva conducted an unannounced Annual/random and increase of capacity Inspection from 8 to 14 children. LPA met with Evangelina Espinoza Guzman, licensee, and explained the reason for the inspection. Present at home was the licensee and her assistant/husband with three preschool age children in care. The adults that reside in the home are herself and her husband Braulio. Per applicant living in the home are her three minor children aged: 13, 7 and 3. All required posting materials were posted. Days and hours of operation are from Monday-Friday from 5:00AM to 5:00PM. Licensee carries day-care insurance with Markel Insurance Company and it’s current. The home received a Fire Inspection Clearance granted on November 4, 2025, by Greenfield Fire Protection District. A pull station was installed near the entrance door. The following areas are not approved for childcare according to the Fire Inspection document: one bedroom, left garden area (gated), right side yard (with porch), laundry room, two storages and half backyard (gated). The playground area is half artificial grass and half cement (gated), with storage and a shadow. Backyard is fenced. Licensee understands the on limits and off-limits areas have been approved by the Fire District Authority and before making any changes to the use of the areas Licensee will notify the Licensing Program. LPA inspected inside and outside of the home. LPA observed no fireplace, screened wall heather, no stairs, and no bodies of water. Licensee stated there are no weapons/ammunition and no pets in the home. Fire/disaster drill was conducted on 11/04/2025. LPA observed a fully charged 3A40BC fire extinguisher was serviced on 10/13/2025, a carbon monoxide detector and smoke detector are operable. The home is clean, orderly, with portable air conditioning and heating system for safety and comfort for children in care. Cleaning products, medications, sharp objects, and other items that are dangerous to children were stored inaccessible in a top kitchen cabinet and laundry room. Report Continues in next pages.

NAME OF LICENSING PROGRAM MANAGER: Susy Cervantes
NAME OF LICENSING PROGRAM ANALYST: Martha Jimenez-Villanueva
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/20/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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: ESPINOZA GUZMAN, EVANGELINA	FACILITY NUMBER: 274417843
	VISIT DATE: 11/20/2025

NARRATIVE

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LPA observed sufficient age-appropriate materials, toys, and play equipment indoors and outdoors areas. The children's bathroom is clean, sanitary, and operable. The home has a working telephone. Licensee stated that a child will be isolated in the entrance room, if necessary, due to illness or communicable disease. Licensee stated that her assistant transports day care children. Licensee understands that children shall not be left unattended in parked vehicles must use appropriate car seats according to the child's age/weight/size and car seat cannot be used for sleeping.

LPA obtained a copy of current children’s roster. LPA reviewed five children's files and the files were complete with the required forms and immunization records. LPA reviewed staff files. Licensee and assistant have current Pediatric CPR/First Aid certifications (expiration: 07/2026 both). Licensee and assistant are current with her Mandated Reporter Training (expiration: 07/20/26 and 02/05/2027) and both have, per SB792, the required immunization records (MMR, Tdap, and flu. LPA reminded Licensee that Mandated Reporter Training must be renewed by all staff every 2 years.

Children were supervised during the inspection and licensee understands that she or a qualified adult must be present in the home during day care hours and ensure that the children are supervised at all times. Licensee understands that she must be present in the home during day care hours (80% of the operating hours). Licensee understands her current capacity options and she understands if eventually she obtains a large license with capacity 14, she cannot have more than 14 children in the home at any time and a qualified assistant must be present and ratio (age of the children) must be observed. Licensee understands in absence of a helper her license capacity is reduced to 8 and ratio must be observed as well. LPA reviewed and provided the capacity worksheet to licensee.

Roster Report was reviewed on 10/28/2025 indicating that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

Report Continues in next pages.

NAME OF LICENSING PROGRAM MANAGER: Susy Cervantes
NAME OF LICENSING PROGRAM ANALYST: Martha Jimenez-Villanueva
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/20/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025

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: ESPINOZA GUZMAN, EVANGELINA	FACILITY NUMBER: 274417843
	VISIT DATE: 11/20/2025

NARRATIVE

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LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at an additional resource. LPA also reminded Licensee of the importance of checking for recalled infant devices https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as 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 stated that she does not administer any medications to the day care children at this time. Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. 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 publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&R's) throughout California.

During the exit interview, the Licensee Evangelina Espinoza Guzman confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process

No deficiencies were cited today. A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with the licensee Evangelina Espinoza Guzman in Spanish and advised her that a large Family Child Care Home license will be approved as November 20, 2025, and will receive the license by postal mail.

NAME OF LICENSING PROGRAM MANAGER: Susy Cervantes
NAME OF LICENSING PROGRAM ANALYST: Martha Jimenez-Villanueva
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/20/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025

LIC809 (FAS) - (06/04)

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