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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444415883
Report Date: 02/27/2020
Date Signed: 02/27/2020 12:20:40 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:BELMONTES, NIEVESFACILITY NUMBER:
444415883
ADMINISTRATOR:BELMONTES, NIEVESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 525-1325
CITY:WATSONVILLESTATE: CAZIP CODE:
95019
CAPACITY:14CENSUS: 1DATE:
02/27/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:55 AM
MET WITH:Nieves BelmontesTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Deanna Villagrana met with licensee Nieves Belmontes for a case management visit. Present were licensee and three year old daughter. LPA asked licensee if she knew were Mayra Ruiz(excluded person) moved to. Licensee stated she moved down the street to 121 Toscano Loop Watsonville, CA 95019. Licensee stated she was in Mexico and returned to notify Mayra she had to move and help find her a place to live. Licensee stated she is closed and will not begin watching children until April 27, 2020 and is taking vacation at this time.

No deficiency was cited during visit.

A notice of site was issued and must be posted for 30 days.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna VillagranaTELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2020
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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