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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444406684
Report Date: 02/07/2023
Date Signed: 02/07/2023 04:42:21 PM


Document Has Been Signed on 02/07/2023 04:42 PM - It Cannot Be Edited

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:COMMUNITY BRIDGES VISTA VERDE CHILD DEV CENTERFACILITY NUMBER:
444406684
ADMINISTRATOR:MARIA HURTADOFACILITY TYPE:
850
ADDRESS:1936 FREEDOM BLVD.TELEPHONE:
(831) 724-3749
CITY:FREEDOMSTATE: CAZIP CODE:
95019
CAPACITY:32CENSUS: 13DATE:
02/07/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Lisa Hindman Holbert & Claudia Marin TIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Elizabeth Larios conducted a unannounced case management. The purpose of the visit is to amend Case Management - Deficiencies visit dated 01/31/2023 (original document). LPA was admitted into the facility by Teacher, Claudia Marin and LPA explained purpose of the visit. Upon arrival there were 3 staff and 13 children present. LPA amended LIC 809-D deficiency cited and the section cited.

Exit interview conducted, report was reviewed with Program Director, Lisa Hindman Holbert .

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Elizabeth LariosTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:
DATE: 02/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/07/2023
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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