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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345920088
Report Date: 06/20/2024
Date Signed: 08/02/2024 10:35:46 AM

Document Has Been Signed on 08/02/2024 10:35 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRALIZED APP UNIT, 744 P STREET, MS 9-14-8201
SACRAMENTO, CA 95814
FACILITY NAME:VISTA ESPERANZAFACILITY NUMBER:
345920088
ADMINISTRATOR/
DIRECTOR:		VALENCIA, BRANDYFACILITY TYPE:
740
ADDRESS:5240 JACKSON STREETTELEPHONE:
(415) 590-0579
CITY:NORTH HIGHLANDSSTATE: CAZIP CODE:
95660
CAPACITY: 54CENSUS: 0DATE:
06/20/2024
TYPE OF VISIT:OfficeANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Michael Weinstein (Licensee), Brandy Valencia (Administrator)TIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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COMP II by CAB successfully completed

Facility Type: RCFE CCE
Application Type: INTL
Capacity: 54
Census : 0
Method: Teams Meeting with CAB
COMP II Participants: Michael Weinstein (Licensee), Brandy Valencia (Administrator), & Tammy Edwards, (Analyst).

Licensee & administrator participated in COMP II via Teams Meeting with CAB Analyst. Identification of licensee/ administrator was verified by confirming driver’s license numbers. During COMP II, licensee/ administrator confirmed the understanding of Title 22. Component II was successfully completed. Licensee/administrator were advised to email signed LIC 809 with copy of photo ID to CAB.

During COMP II, CAB analyst confirmed licensee's/administrator’s understanding of following areas:
1. Facility operation: License type, client/resident populations, and program
2. Admission Policies
3. Staffing requirements & Training
4. Restrictive/Prohibited Health Conditions
5. General provisions
6. Emergency Preparedness
7. Complaints & Reporting
SUPERVISORS NAME: Darla Neeley
LICENSING EVALUATOR NAME: Tammy Edwards
LICENSING EVALUATOR SIGNATURE: DATE: 06/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/24/2024
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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