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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444406156
Report Date: 06/26/2023
Date Signed: 06/26/2023 11:37:00 AM

Document Has Been Signed on 06/26/2023 11:37 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, VERONICAFACILITY NUMBER:
444406156
ADMINISTRATOR:VERONICA SANDOVALFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 587-9289
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
06/26/2023
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:28 AM
MET WITH:Veronica SandovalTIME COMPLETED:
11:38 AM
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Licensing Program Analyst (LPA), Cortney Nelson, and Licensing Program Manager (LPM), Joel Segura, met with Licensee, Veronica Sandoval, to review probationary license limitations and conditions.

Per California Department of Social Services Stipulation, Waiver and Order (Case Number 6922262101), Veronica's Family Child Care Home (FCCH) license will be in a probationary state for two (2) years with required conditions. LPM Segura reviewed conditions with Veronica, including the requirement for obtaining criminal record clearances/exemptions and maintaining copy of proper identification for all individuals working, residing, volunteering, or having a regular presence in the FCCH.

LPM Segura advised that per AB633, for the full duration of the probationary period (two years), the Licensee shall inform all current and prospective parents of the probationary license and provide a copy of the Stipulation and Accusation. Parents/authorized representatives shall sign an acknowledgement (LIC9224) that they have received a copy of the Stipulation and Accusation and the acknowledgement shall be maintained in the child's file. The acknowledgement shall be made available for Department review upon request.

The FCCH shall be subject to increased visits by the Department to ensure compliance with Stipulation and probationary license conditions. The Licensee understands that violation of any of the terms of the Stipulation shall constitute sufficient grounds for revocation of the probationary license.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE: DATE: 06/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/26/2023
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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