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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444414517
Report Date: 03/08/2024
Date Signed: 03/08/2024 12:49:19 PM

Document Has Been Signed on 03/08/2024 12:49 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:VILLANUEVA, EUGENIA & IVONNEFACILITY NUMBER:
444414517
ADMINISTRATOR:VILLANUEVA,EUGENIA&IVONNEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 840-9599
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY: 14TOTAL ENROLLED CHILDREN: 3CENSUS: 2DATE:
03/08/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Eugenia VillanuevaTIME COMPLETED:
01:00 PM
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Licensing Program Analysts (LPAs) Deanna Villagrana and Martha Jimenez Villanueva conducted an unannounced Case Management Visit to serve the Immediate Exclusion for licensee Eugenia Villanueva's son Javier Kevin Villanueva. Present were licensee, licensee's son Javier Kevin Villanueva and two day care children including one infant.

LPAs provided the notice of immediate exclusion of Javier Kevin Villanueva. LPAs also provided Javier Kevin Villanueva his notice of immediate exclusion.

Licensee understands that failure to comply with the California Department of Social Services (CDSS) Order of Exclusion shall be grounds for disciplining her as the licensee, including suspension or revocation of her license.

LPAs also provided and reviewed the "Family Child Care Home Addendum to Notification of Parents' Rights Regarding Removal/Exclusion)". Licensee understands that she must provide a copy to the parents and must obtain their original signature and keep the document in the child's file.

No deficiency was cited.

Notice of Site was issued and must be posted for 30 days.
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Deanna Villagrana
LICENSING EVALUATOR SIGNATURE: DATE: 03/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/08/2024
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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