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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444406079
Report Date: 08/26/2021
Date Signed: 08/26/2021 01:37:02 PM

COMPREHENSIVE INSPECTION
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:SANDOVAL, MARIA & FELIX, RAMIROFACILITY NUMBER:
444406079
ADMINISTRATOR:SANDOVAL, MARIA & FELIX, RFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 763-1467
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:14CENSUS: DATE:
08/26/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Maria SandovalTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Elizabeth Berumen met with Licensee, Maria Sandoval for unannounced Required – 1 year annual inspection. LPA was granted access to the home by the Licensee. No day care children were present. Licensee states that she is currently closed and has not been caring for children this year. She is closed due to pandemic and decided to remodel her home. Licensee requested to be placed on inactive status from today, 08/26/2021 - 01/24/2022.
Licensee agrees to comply with all of the following conditions: a. I will not provide child care for which a license is required until my license is reactivated. b. I will continue to promptly pay the annual license fee. c. I will inform your office of any changes in the above dates prior to re-opening my facility by submitting a new LIC 9211. d. I will be in compliance with all licensing laws and regulations upon re-opening my facility, including but not limited to: ● Ensuring all adult staff and residents, including children who turn 18 during the inactive period, have criminal record clearances ● Maintaining current CPR and First Aid certifications ● Maintaining a current fire extinguisher and functioning smoke alarms.
LPA informed Licensee that her annual fee of $120.00 is due tomorrow, August 27, 2021. Licensee states she submitted her payment on July 27, 2021. Licensee is going to verify with her bank if the check was cashed and will contact LPA.

LPA also informed her that her daughter, Priscilla Felix- Sandoval has not been fingerprint cleared. Priscilla Felix - Sandoval 7517542113 has a pending status. Licensee states that her daughter is currently living in Monterey and attending the University of Monterey. Licensee also states that she would like to remove her husband, Ramiro Felix from her license. LPA provided her with an application for her to update.
NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth BerumenTELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021
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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