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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075700215
Report Date: 12/01/2021
Date Signed: 12/01/2021 02:08:41 PM

Document Has Been Signed on 12/01/2021 02:08 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:KRANZ, ESMERALDAFACILITY NUMBER:
075700215
ADMINISTRATOR:KRANZ, ESMERALDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 872-5976
CITY:SAN RAMONSTATE: CAZIP CODE:
94583
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
12/01/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Esmeralda KranzTIME COMPLETED:
02:20 PM
NARRATIVE
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On December 1, 2021 at 12:55pm, Licensing Program Analyst (LPA) Julia Placencia conducted a case management inspection while at the facility for another reason. LPA met with licensee Esmeralda Kranz. Also present were helper Grace O’Connor and 11 children (4 infants and 7 preschoolers).

An unusual incident occurred at the facility on 10/8/21 which resulted in a child being bit on both cheeks. Licensee did not report the incident to Licensing as required. During the inspection, reporting requirements were reviewed and licensee received a copy.

See 809D for deficiencies cited today. Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.


Exit interview conducted with licensee Esmeralda Kranz and copy of report provided. Notice of Site Visit provided and must be posted for 30 days.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Julia Placencia
LICENSING EVALUATOR SIGNATURE: DATE: 12/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/01/2021
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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Document Has Been Signed on 12/01/2021 02:08 PM - It Cannot Be Edited


Created By: Julia Placencia On 12/01/2021 at 01:34 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
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: KRANZ, ESMERALDA
FACILITY NUMBER: 075700215

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/01/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/08/2021
Section Cited
CCR
102416.2(d)

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102416.2(d) Reporting Requirements -
The licensee shall report to the Department as provided by Health and Safety Code 1597.467(b)(1) and (2).
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Licensee shall review the regulation regarding reporting requirements. Licensee shall submit a statement indicating she understands her responsibility regarding reporting requirements. Submit statement by due date of 12/8/21.
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This requirement was not met as evidenced by: Based on interview and records review, the licensee did not report an unusual incident to Licensing. This poses a potential health and safety, or personal rights risk to children in care.
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Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.

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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:Jason Jang
LICENSING EVALUATOR NAME:Julia Placencia
LICENSING EVALUATOR SIGNATURE:
DATE: 12/01/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/01/2021


LIC809 (FAS) - (06/04)
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