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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444409058
Report Date: 08/15/2019
Date Signed: 08/15/2019 12:32:22 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:HERRERA, FLORENCIAFACILITY NUMBER:
444409058
ADMINISTRATOR:FLORENCIA HERRERAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 740-2288
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:14CENSUS: 8DATE:
08/15/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Florencia HerreraTIME COMPLETED:
12:45 PM
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A visit was made by Analyst Behbood to inspect and review the correction required as result of annual visit on 07/24/19. Licensee provided the following:
Certificate of completion of the mandated Child Abuse Reporter for her, 2 sons, husband, her helper Letty Herrera. Files for Child #1, 2 and 3 were reviewed.
She still doesn't have immunization record due to her dr. no longer in business and one of her helper still needs immunization record, however she provided immunization record for her other potential helpers. She has conducted fire drill and documented on 07/24/19. There was no medication or other toxin accessible to children and children were supervised during visit.
So all citation except her and her helpers immunization are cleared.
She agreed to get her and her helper's immunization no later than 08/29/19.
No additional 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: 08/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2019
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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