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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444406219
Report Date: 12/21/2023
Date Signed: 12/21/2023 12:28:08 PM

Document Has Been Signed on 12/21/2023 12:28 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:GONZALEZ, ELIZABETHFACILITY NUMBER:
444406219
ADMINISTRATOR:GONZALEZ, ELIZABETHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 761-2190
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
12/21/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Elizabeth GonzalezTIME COMPLETED:
12:37 PM
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
Licensing Program Analysts (LPAs), Cortney Nelson and Liridon "Doni" Fici, met with Licensee, Elizabeth Gonzalez, and explained purpose of visit, to follow-up on capacity/staffing compliance and review children's files. Upon arrival, LPAs were admitted into the home by the Licensee.

LPAs observed there were ten (10) children in care (8 preschool-age, 1 school-age, and 1 infant) and three staff members present (Elizabeth, Yosemite, & Diana). All staff have criminal record clearances and are associated to the home.

LPAs reviewed children's files for those present today and all children had Acknowledgement of Receipt of Licensing Report (LIC9224) for all previous Type A citations.

As a result of today's inspection, no deficiencies were cited.

Exit interview conducted and report was reviewed with the Licensee, Elizabeth Gonzalez.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST BE POSTED FOR 30 DAYS.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE: DATE: 12/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/21/2023
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