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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 440709561
Report Date: 05/08/2019
Date Signed: 05/08/2019 02:23:12 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:PAJARO VALLEY CHILDREN'S CENTER - INFANTSFACILITY NUMBER:
440709561
ADMINISTRATOR:ROSA MENDOZAFACILITY TYPE:
830
ADDRESS:234 MONTECITO STREETTELEPHONE:
(831) 722-3737
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:8CENSUS: 7DATE:
05/08/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Rosa MendozaTIME COMPLETED:
02:30 PM
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An unannounced visit was made by Analyst Behbood to follow up on citations issued during annual visit on 04/25/19.
The following were inspected:
Certificate of Training for Mandated Child Abuse Reporter- All staff have certificate now except one, she is out on leave. Rose will send the certificate for that staff when she is back from leave.
Children's Need and Service Plan reviewed they all are now updated.
All citations are now corrected.

No additional citations issued.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Mahvash BehboodTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2019
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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