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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444409847
Report Date: 10/16/2019
Date Signed: 10/16/2019 03:38:56 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:ACOSTA, BEATRIZ AFACILITY NUMBER:
444409847
ADMINISTRATOR:BEATRIZ ACOSTAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 724-3129
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:14CENSUS: 3DATE:
10/16/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Beatriz AcostaTIME COMPLETED:
03:50 PM
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An unannounced random visit made by Analyst Mahvash Behbood. Kit #2 was used for this inspection. Present were Beatriz, licensee, 3 day care children. Living in this facility are, licensee, her husband, her mother in law and her 3 children;14,15 and 20 years old. All adults living at home are finger printed and cleared. Beatriz understands that all adults that live in the home or help with the children must have a clearance before they can be present. Failure to do so will result in a fine. Hours of operation is Monday through Friday from 6 AM to 6 PM. Inside and outside of the facility was toured. Off limit area inside the home: entire upstairs and the garage. Off limit area outside is the gated side yard.
The licensee is not providing IMS (Incidental Medical Services) at this time.
There are no bodies of water in the backyard. Beatriz states there are no weapons in the home. Cleaning supplies, medicines & similar items stored inaccessible to children
The stair case leading to second floor is barricaded with a gate, there is no wall heater
There is a fully charged correct size fire extinguisher, working smoke alarm and carbon monoxide detector. Home is clean, with working central heat.
Licensee has working land line/ telephone. Children were supervised during the visit.
Children play in the backyard which is fenced. There are plenty of age appropriate toys and play equipment
Beatriz has a current children roster. Fire/disaster drills are documented.
Beatriz and her helper have current pediatric 1st aid/CPR which expires on 1/27/2021. Training on Mandated Child Abuse Reporter were taken on 02/21/2018, she understand this training must be renewed every 2 years. Proof of immunization for her and her helper reviewed and are complete. Licensee doesn't transport children.
Children's file were reviewed and they all contained LIC 700 (identification and emergency information).
No violations of Title 22 noted.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Mahvash BehboodTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2019
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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