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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444407366
Report Date: 08/22/2019
Date Signed: 08/22/2019 03:53:40 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:CERVANTES, ROSIEFACILITY NUMBER:
444407366
ADMINISTRATOR:CERVANTES, ROSIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 728-7263
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:14CENSUS: 6DATE:
08/22/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Rosie CervantesTIME COMPLETED:
04:05 PM
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A visit was made Analyst Behbood to check up on the citation issued during last visit on 08/09/19. Met Rosie, Licensee. Present also were 6 children and her mom. Back yard was inspected. The hot tub is removed from the premises. Citation is now clear.
No citation issued during today's visit.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Mahvash BehboodTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2019
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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