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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274409442
Report Date: 11/07/2025
Date Signed: 11/07/2025 04:18:59 PM

Document Has Been Signed on 11/07/2025 04:18 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:GARCIA, BERTHAFACILITY NUMBER:
274409442
ADMINISTRATOR/
DIRECTOR:		GARCIA, BERTHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 206-5895
CITY:SALINASSTATE: CAZIP CODE:
93906
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
11/07/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:53 PM
MET WITH:Cynthia Ortiz & Bertha Garcia TIME VISIT/
INSPECTION COMPLETED:
04:15 PM
NARRATIVE
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On 11/7/2025 at 1:53PM, Licensing Program Analyst (LPA) Elizabeth Larios met with Assistant, Cynthia Ortiz for an unannounced Plan of Correction (POC) inspection and to also verify if licensee is operating according with regulations. The purpose of today's inspection is to follow up on a deficiency issued on 10/17/2025. Upon arrival, LPA observed assistant with seven day care children (one infant and six preschoolers).

During today's inspection, LPA toured the inside of facility and observed Notice of Site Visit dated 10/17/2025 posted near the front entrance. LPA observed Complaint Investigation Report dated 10/17/2025 and Deficiency Type A, was not posted. During visit Licensee Bertha posted report and deficiency Type A. LPA also reviewed children files and observed Acknowledge of Receipt of Licensing Reports (LIC9224) that needs to be signed by the parent(s)/legal guardians is not in the files. Licensee, Bertha arrived shortly and provided LPA the LIC 9224 forms signed by parent(s)/legal guardians that were in a folder in her kitchen table. LPA reviewed LIC 9224 forms observed child (C11) did not have a signed LIC 9224 form.

The following type B deficiencies were cited on the attached page (LIC 809-D). Licensee was informed that failure to correct the deficiencies by the specified Plan of Correction (POC) due date may result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made. Immediate Civil Penalty of $100 was issued today.

Exit interview conducted and report was reviewed with the Licensee, Bertha Gracia and appeal rights provided.



A notice of site visit was given and must remain posted for 30 days.
NAME OF LICENSING PROGRAM MANAGER: Deanna Villagrana
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Larios
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 11/07/2025 04:18 PM - It Cannot Be Edited


Created By: Elizabeth Larios On 11/07/2025 at 03:11 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: GARCIA, BERTHA
FACILITY NUMBER: 274409442

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/10/2025
Section Cited
HSC
1596.8595(a)(1)(3)

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(a)(1) Each licensed child day care facility shall post a copy of any licensing report pertaining to the facility that documents either a facility visit or a complaint investigation that results in a citation for a violation that, if not corrected, will create a direct and immediate risk to the health, safety, or personal rights of children in care. The licensing report provided by the department shall be posted immediately upon receipt, adjacent to the postings required pursuant to Section 1596.817 and on, or immediately adjacent to, the interior side of the main door to the facility and shall remain posted for 30 consecutive days.(3) Failure to comply with paragraph (1) shall result in an immediate civil penalty of one hundred dollars ($100).
This requirement is not met as evidenced by:
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Licensee posted Complaint Report and Deficiency Type A dated 10/17/2025 during visit. Deficiency corrected during visit.

Immediate Civil Penalty of $100 issued today.
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Based on observation and interview, Licensee did not comply with the section cited above. LPA observed the Complaint Report and Deficiency Type A, was not posted. Per Licensee she had it posted but removed it to show it to staff and forgot to posted it again which poses an immediate health, safety or personal rights risk to persons in care.
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Type B
11/10/2025
Section Cited
HSC1596.8595(c)(1)

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(c)(1) A licensed child day care facility shall provide to the parents or guardians of each child receiving services in the facility copies of any licensing report that documents any Type A citation that represents an immediate risk to the health, safety, or personal rights of children in care. This requirement is not met as evidenced by:
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Licensee will submit proof of complete LIC 9224 form for child C11 to CCLD by POC due date 11/10/2025.
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Based on observation and interview, the licensee did not comply with the section cited above. LPA observed that the Acknowledge of Receipt of Licensing Reports (LIC9224) have not been signed by the parent(s)/legal guardians for one child C11 which poses a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Deanna Villagrana
NAME OF LICENSING PROGRAM MANAGER:
Elizabeth Larios
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 11/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/07/2025


LIC809 (FAS) - (06/04)
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