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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 440703702
Report Date: 01/15/2020
Date Signed: 01/15/2020 01:18:20 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/V.GARCIAFACILITY TYPE:
850
ADDRESS:32 MADISON STREETTELEPHONE:
(831) 728-6280
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:90CENSUS: 37DATE:
01/15/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:K Lathrop & V. GarciaTIME COMPLETED:
01:30 PM
NARRATIVE
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Licensing Program Analyst (LPA), Mahvash Behbood, conducted an unannounced case management inspection to the Facility in response to an Unusual Incident that the Facility self reported to the San Jose Regional Office (SJRO).
Met Vanessa Garcia, Site Supervisor. Purpose of visit explained. Bathroom was inspected. The security camera recorded the incident. Analyst watched the tape of the incident. Kathy Lathrop, Program Director arrived during the visit. Supervision issues were discussed in details including steps taken by the agency to improve supervision. Copies of topic discussed during staff training was 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: 01/15/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2020
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: 01/15/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/22/2020
Section Cited

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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.
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This requirement was not met as
evidenced by: A child was left
alone in the bathroom, child was observed by staff coming out of the bathroom by herself. This is an immediate Health & Safety Risk to children in care.
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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: 01/15/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/15/2020
LIC809 (FAS) - (06/04)
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