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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 270710460
Report Date: 10/04/2023
Date Signed: 10/04/2023 12:22:39 PM

Document Has Been Signed on 10/04/2023 12:22 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:NATIVIDAD PRESCHOOLFACILITY NUMBER:
270710460
ADMINISTRATOR:TOMAS LOPEZFACILITY TYPE:
850
ADDRESS:1465 MODOC STREETTELEPHONE:
(831) 753-5675
CITY:SALINASSTATE: CAZIP CODE:
93906
CAPACITY: 48TOTAL ENROLLED CHILDREN: 11CENSUS: 7DATE:
10/04/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Anally ZagalTIME COMPLETED:
12:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Fermin Campos-Jaramillo met with lead teacher Anally Zagal in a Case Management inspection with the purpose of investigating an Unusual Incident self reported by the Center to the Licensing Program on. LPA interviewed teacher Zagal and teacher Nancy Martinez Gutierrez. Form LIC812 was created with the interviews.

No deficiencies cited today.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE: DATE: 10/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/04/2023
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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