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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 354405315
Report Date: 05/05/2022
Date Signed: 05/05/2022 03:47:14 PM


Document Has Been Signed on 05/05/2022 03:47 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:JAURIGUE, VIRGINIAFACILITY NUMBER:
354405315
ADMINISTRATOR:VIRGINIA JAURIGUEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 801-2249
CITY:HOLLISTERSTATE: CAZIP CODE:
95023
CAPACITY:14CENSUS: 4DATE:
05/05/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Virginia JaurigueTIME COMPLETED:
03:55 PM
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Licensing Program Analyst (LPA) Deanna Villagrana met with Virginia Jaurigue for a case management visit. LPA explained the reason for the visit. Present were licensee, licensee's adult son, 15 year old son, 12 year old daughter and four day care children.

Licensee reported to LPA on 05/03/2022 and unusual incident that occurred on 05/02/2022 regarding her dog biting a day care child. Upon arrival, LPA observed five dogs running around in the backyard. Licensee stated the children have been inside and her son let the dogs out to relieve themselves. LPA observed a new kennel in a box in the backyard. Licensee states her son will be assembling it this evening. LPA requested photos of the kennel assembled be sent to her no later than 05/06/2022.

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: 05/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/05/2022
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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