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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 440703702
Report Date: 05/29/2019
Date Signed: 05/29/2019 02:09:05 PM

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:WATSONVILLE CHILDREN'S CENTERFACILITY NUMBER:
440703702
ADMINISTRATOR:K.LATHROP/C.GUTIERREZFACILITY TYPE:
850
ADDRESS:32 MADISON STREETTELEPHONE:
(831) 728-6280
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:90CENSUS: DATE:
05/29/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Vanessa GarciaTIME COMPLETED:
02:15 PM
NARRATIVE
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An unannounced visit was made to follow up on self reported incident. Met Vanessa, Site Coordinator. Purpose of visit explained. Her statement was taken. Play ground and classroom was inspected. Teacher involved was interviewed. Pertinent document obtained.
Please see next page for citation under Title 22.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Mahvash BehboodTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2019
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: WATSONVILLE CHILDREN'S CENTER
FACILITY NUMBER: 440703702
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/29/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/04/2019
Section Cited
CCR
101229(a)(1)
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Responsibility for Providing Care and Supervision- No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
Based on the information provided in the incident report and interviews conducted during visit, a child remained in the playground unsupervised when the rest of the children and staff went inside for lunch. This pose an immediate danger to health and safety of children.
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Effective immediately all children must be visually supervised.
Vanessa explained the new procedure that has been created after the incident to prevent this from occurring. She is to put the new procedure in writing and send it to analyst no later than 06/04/19.
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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: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Mahvash BehboodTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2019
LIC809 (FAS) - (06/04)
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