<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
444406076
Report Date:
11/03/2021
Date Signed:
11/03/2021 10:43:42 AM
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:
HIPPERT, MARTHA & MILDRED
FACILITY NUMBER:
444406076
ADMINISTRATOR:
HIPPERT, MARTHA & MILDRED
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(831) 335-2474
CITY:
FELTON
STATE:
CA
ZIP CODE:
95018
CAPACITY:
14
CENSUS:
DATE:
11/03/2021
TYPE OF VISIT:
POC
UNANNOUNCED
TIME BEGAN:
09:30 AM
MET WITH:
Martha Hippert
TIME COMPLETED:
11:30 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensee Program Analyst (LPA) Goodell met with licensee Martha Hippert for a POC inspection for deficiency that was cited on 10/20/21. During inspection LPA observed five children present with licensee. All individuals subject to criminal background review have obtained a criminal record clearance.
During inspection LPA toured all areas accessible to children. LPA also toured the off-limits outdoor area and observed the non-operating jacuzzi
dismantled. Therefore POC cleared.
No deficiencies cited.
This facility evaluation report was reviewed and discussed with the licensee. A notice of site visit issued and remain posted for 30 days. Licensee acknowledged that a copy of this report will remain on file for a period of three years for public review upon request.
SUPERVISOR'S NAME:
Diana Stephenson
TELEPHONE:
(408) 324-2128
LICENSING EVALUATOR NAME:
Kristal Goodell
TELEPHONE:
(408) 489-9484
LICENSING EVALUATOR SIGNATURE:
DATE:
11/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/03/2021
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
1