<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 270757809
Report Date: 05/10/2023
Date Signed: 05/10/2023 12:53:46 PM


Document Has Been Signed on 05/10/2023 12:53 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:MARTA, VICTORIAFACILITY NUMBER:
270757809
ADMINISTRATOR:VICTORIA MARTAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 724-9535
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:14CENSUS: 1DATE:
05/10/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Victoria MartaTIME COMPLETED:
01:00 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
Licensing Program Analyst (LPA) Deanna Villagrana met with licensee Victoria Marta for a required one year visit. LPA explained the nature of the visit. Present were licensee, foster child age one, two men and one lady cleaning the outside of the home and on one of the men's underage daughter.

Licensee stated she was not open due to the recent storms. She stated her, her husband and two foster children are staying at the fairgrounds temporarily until they are approved to live in the home. She stated they are allowed to come back in to the home to clean. LPA observed the home with storage boxes and garbage bags of items licensee states are things she packed quickly when they were asked to evacuate. Licensee states she will re-open hopefully next week but would keep the Department informed. LPA observed licensee had a CPR/First Aid certificate that expires 01/22/2024 and completed Mandated Reporter training on 03/07/2023. The last fire drill was conducted on 12/05/2022. LPA did not go into the backyard play area due to the men pressure washing and removing debris. LPA notified licensee a second visit will be conducted when she begins operating.

No deficiency was cited.

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.

SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna VillagranaTELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:
DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/10/2023
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 1