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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444413610
Report Date: 06/01/2023
Date Signed: 06/01/2023 10:59:16 AM

Document Has Been Signed on 06/01/2023 10:59 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:COVARRUBIAS, OLIVIAFACILITY NUMBER:
444413610
ADMINISTRATOR:COVARRUBIAS, OLIVIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 786-6777
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 12DATE:
06/01/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Olivia CovarrubiasTIME COMPLETED:
11:10 AM
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Licensing Program Analyst (LPA) Deanna Villagrana met with licensee Olivia Covarrubias for a Plan of Correction (POC) visit. LPA explained the reason for the visit. Present were licensee, licensee's two adult daughters, assistant Maria Gonzalez and 12 day care children including four infants.

LPA observed updated immunization records for three children who needed immunization records updated on report dated 05/19/2023. One child is still missing LIC627. LPA observed immunization record for assistant Maria Gonzalez. LPA did not observe a current Mandated Reporter certificate for assistant Maria Gonzalez. LPA reviewed two additional children's files.

No deficiency was cited.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Deanna Villagrana
LICENSING EVALUATOR SIGNATURE: DATE: 06/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/01/2023
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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