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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
444408896
Report Date:
05/02/2019
Date Signed:
05/02/2019 01:32:18 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:
SALSIPUEDES STATE PRESCHOOL
FACILITY NUMBER:
444408896
ADMINISTRATOR:
MARINA ANTUNA
FACILITY TYPE:
850
ADDRESS:
115 CASSERLY ROAD
TELEPHONE:
(831) 728-7812
CITY:
WATSONVILLE
STATE:
CA
ZIP CODE:
95076
CAPACITY:
23
CENSUS:
20
DATE:
05/02/2019
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
01:05 PM
MET WITH:
Carmen
TIME COMPLETED:
01:40 PM
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An unannounced case management visit was made by Analyst Behbood to deliver an amended report. Present were 20 children with 3 staff. The purpose of visit explained.
No citation issued today.
SUPERVISOR'S NAME:
Anthony Studebaker
TELEPHONE:
(408) 324-2155
LICENSING EVALUATOR NAME:
Mahvash Behbood
TELEPHONE:
(408) 334-8552
LICENSING EVALUATOR SIGNATURE:
DATE:
05/02/2019
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
05/02/2019
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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