<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444409066
Report Date: 04/21/2022
Date Signed: 04/21/2022 03:23:59 PM


Document Has Been Signed on 04/21/2022 03:23 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:GILBERTSON, PATRICIAFACILITY NUMBER:
444409066
ADMINISTRATOR:PATRICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 438-5437
CITY:SCOTTS VALLEYSTATE: CAZIP CODE:
95066
CAPACITY:14CENSUS: 3DATE:
04/21/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:27 PM
MET WITH:Patricia GilbertsonTIME COMPLETED:
03:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA), Cortney Nelson, conducted unannounced case management visit and met with Licensee, Patricia Gilbertson.

LPA explained purpose of visit, to inspect recently renovated on-limits room for day care children. Construction on day care room was to renovate the following- permitted AC/Heater unit, replaced all doors, installed new flooring, and new paint.

All shelves in the room are bolted to the walls and are earthquake safe. The room has functioning carbon monoxide detector, smoke detector, and 2A10BC fire extinguisher. There are adequate toys for children to play. Furniture in the room is clean, safe, and appropriate sized for children.

The room that was previously used for the day care children will still be on-limits, however it will not be the primary room for care. The newly renovated room will be the primary room for day care supervision.

All required postings are posted near the entrance of the room.

As a result of todays inspection, no deficiencies were cited.

Exit interview was conducted with Licensee, Patricia Gilbertson.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney NelsonTELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:
DATE: 04/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/21/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1