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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444409060
Report Date: 02/22/2022
Date Signed: 02/22/2022 11:12:22 AM

Document Has Been Signed on 02/22/2022 11:12 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:MENA, MONICAFACILITY NUMBER:
444409060
ADMINISTRATOR:MONICA MENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 348-7110
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY: 14TOTAL ENROLLED CHILDREN: 13CENSUS: 7DATE:
02/22/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:51 AM
MET WITH:Monica MenaTIME COMPLETED:
11:20 AM
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Licensing Program Analyst (LPA) Janette Cruz, conducted an unannounced follow-up case management inspection today to deliver an amended report on a complaint investigation visit dated 02/17/22.

An exit interview was conducted with Licensee, Monica Mena.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE: DATE: 02/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2022
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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