<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444406164
Report Date: 10/02/2024
Date Signed: 10/02/2024 11:09:39 AM

Document Has Been Signed on 10/02/2024 11:09 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:FERNANDEZ, MARIAFACILITY NUMBER:
444406164
ADMINISTRATOR/
DIRECTOR:		FERNANDEZ, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 228-1573
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
10/02/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Maria FernandezTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 10/02/24 at 9:25 AM., Licensing Program Analyst (LPA), Teodoro Trujillo, met with Licensee, Maria Fernandez, for a Plan of Correction (POC) inspection. LPA observed one infant inside a crib and one preschool age in a high chair. Licensee was cited on September 12, 2024 under Operation of A Family Child Care Home. LPA toured the home.

LPA observed the following:
1) Four children: 1 infant (inside crib during circle time) and 9 preschool age (one child sitting in a high chair) present in the home.
2) Fire exit to left side cleared, security latch from outside area open.

Licensee was provided LIC99A Facility Sketch, and LIC 610 Emergency Disaster Plan forms to complete and to send to the Regional Office. PIN 20-24-CCP-SP was provided to licensee.

As a result of this inspection, deficiency under Operation of A Family Child Care Home is hereby corrected and cleared.

There were no deficiencies cited.

A Notice of Site Visit was issued and must remain posted for 30 days.
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE: DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/02/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1