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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444410325
Report Date: 12/13/2019
Date Signed: 12/13/2019 12:35:37 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:PANZICH, ELIZABETHFACILITY NUMBER:
444410325
ADMINISTRATOR:ELIZABETH PANZICHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 728-3827
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:14CENSUS: 7DATE:
12/13/2019
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Elizabeth PanizichTIME COMPLETED:
12:35 PM
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The purpose of the inspection is the facility is currently under increased monitoring as agreed upon during the Informal Meeting between the Licensee and Community Care Licensing Management conducted on 09/07/19.
Met Elizabeth Panizich, Licensee. Purpose of visit explained. Present also were 7 children 2 of which under 2 years old. She expect 3 school age children to arrived after school.
Elizabeth who wanted to get a new dog stated that she has founded one she likes.
Inside and outside of facility including the off limit out door area were inspected. Children roster reviewed with her. She provided her new certificate of Mandated Child Abuse Reporter taken on 12/01/19. CPR, First Aid certificate expires on 04/28/19.
No deficiency was noted therefore no citation issued.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Mahvash BehboodTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2019
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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