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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444407897
Report Date: 12/16/2022
Date Signed: 12/21/2022 01:46:56 PM

Document Has Been Signed on 12/21/2022 01:46 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:MELGOZA, GLORIAFACILITY NUMBER:
444407897
ADMINISTRATOR:MELGOZA, GLORIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 722-8732
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
12/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Gloria MelgozaTIME COMPLETED:
04:15 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 Analyst (LPA) Elizabeth Berumen conducted an unannounced one year required inspection to the home today. LPA met with Licensee, Gloria Melgoza and explained the nature of today's inspection to her. Days and hours of operation are Monday to Friday from 6:00 AM to 6:00 PM.

LPA observed five children during today's inspection; 3 infants and 2 preschoolers. Licensee's assistant, Mary Fernandez Wong.

Licensee's Certifications for CPR and First Aid card have expired on 12/15/2024.

LPA toured the indoor and outdoor areas of the home during today's inspection. Off limit areas in the home are entire upstairs (master bedroom/bath bedrooms, 2 bedrooms and 1 bathroom) and garage. LPA observed barricaded stairs and barricaded fire place. The door the the off limit garage is locked. Backyard is fenced.

LPA reviewed current Child Care Facility Roster during today's inspection. Licensee has documented a fire drill during the last six months. Last fire drill was documented on 12/05/22.

The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. Licensee was advised she can use the back yard when she has replaced the trampoline's net. LPA observed a fully charged 2A10BC fire extinguisher and working smoke/carbon detectors. No bodies of water were observed. The Licensee states that she does not have any weapons in the home. All detergents, cleaning compounds, medications, and other similar items are stored inaccessible to children.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE: DATE: 12/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2022
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: MELGOZA, GLORIA
FACILITY NUMBER: 444407897
VISIT DATE: 12/16/2022
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
26
27
28
29
30
31
32
LPA reviewed five children files during today's inspection for the following records: Notification of Parents Rights (LIC995A), Consent for Emergency Medical Treatment (LIC627), Identification and Emergency Information (LIC700), Affidavit Regarding Liability Insurance (LIC 282), Individual Infant Sleeping Plan (LIC 9227), and Immunization Records (PM 286/CDPH 286). Two infants were missing the LIC9227.

Gloria Melgoza's Mandated Reporter Training expires on 01/21/2024. LPA reminded Licensee that Mandated Reporter Training must be renewed by all staff every 2 years.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process


Exit interview conducted and report was reviewed with Licensee, Gloria Melgoza.

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

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2