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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444406079
Report Date: 05/10/2023
Date Signed: 05/10/2023 11:08:44 AM

Document Has Been Signed on 05/10/2023 11:08 AM - 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:SANDOVAL, MARIAFACILITY NUMBER:
444406079
ADMINISTRATOR:SANDOVAL, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 763-1467
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
05/10/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Maria SandovalTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Elizabeth Berumen met with Licensee, Maria Sandoval for a case management visit. Maria is adding a room that was previously off limits to on limits.
LPA inspected the entire home today. Licensee will use the master bedroom/bathroom and front entry living room for primary day-care areas. Licensee will use the second living room area for children to pass through when going to the outdoor play area. Licensee will use the left side of the backyard for children. The detached garage is off-limits and right fenced off area of the backyard is off limits to children.

LPA requested an updated facility sketch; the current sketch is not labeled correctly. Licensee, Maria Sandoval agrees to submit the sketch to LPA by 05/17/23.

No deficiency cited.

NOTICE OF SITE VISIT WAS POSTED AND MUST REMAIN POSTED FOR 30 DAYS
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE: DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/10/2023
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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