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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 354404553
Report Date: 07/27/2022
Date Signed: 07/29/2022 08:51:24 AM


Document Has Been Signed on 07/29/2022 08:51 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:PALMERIN ZAMUDIO, MARTINAFACILITY NUMBER:
354404553
ADMINISTRATOR:MARTINA PALMERIN ZAMUDIOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 524-2327
CITY:HOLLISTERSTATE: CAZIP CODE:
95023
CAPACITY:14CENSUS: 3DATE:
07/27/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Martina Palmerin ZamudioTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Deanna Villagrana met with licensee Martina Palmerin Zamudio for a required one year visit. LPA explained the nature of today’s inspection to her. Present were licensee and licensee's adult daughter and three day care children including two infants.

Licensee reported to CCLD on 07/12/2022 of an incident that occurred at her facility regarding children hitting and kicking another child. After interviewing staff and child who was the one being hit, it is determined that licensee used her authority to grab a child's arm to protect another child from serious injury.

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: 07/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2022
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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