444417940-9-16-2026-07-CC-SMUA-DXYTXY-20260916150754

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444417940
Report Date: 09/16/2026
Date Signed: 09/16/2026 03:08:27 PM

Document Has Been Signed on 09/16/2026 03:08 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:	CLELAND, MICHELLE		FACILITY NUMBER:	444417940
ADMINISTRATOR/ DIRECTOR:	MICHELLE CLELAND		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 254-5113
CITY:	Watsonville	STATE: CA	ZIP CODE:	950769638
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 8	CENSUS: 5	DATE:	09/16/2026
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:30 PM
MET WITH:	Michelle Cleland		TIME VISIT/ INSPECTION COMPLETED:	03:20 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	On September 16, 2026, Licensing Program Analysts (LPAs), Sara Mulugeta and Darnella Aulani, conducted an unannounced annual inspection. LPAs were granted access to the home by Licensee, Michelle Cleland and explained the nature of today’s inspection. Present in the home were licensee, assistant, and 5 preschool age children. Licensee was operating within the ratio and capacity requirements of the license. Current days and hours of operation are Monday to Thursday, 8:00 AM - 2:30 PM. LPAs observed all required posted materials near the front entrance. LPAs conducted a walkthrough of the indoor and outdoor areas. The home was clean and orderly, and well ventilated, with appropriate toys and learning materials. One bedroom is off-limits. The home was free from observable defects or conditions that could endanger a child. No fireplaces or open-faced heaters were observed. Hazardous materials, including poisons, detergents, cleaning compounds, and medicines, were stored in locations inaccessible to children. Licensee understands that smoking is prohibited in the home. Licensee states there are no weapons or pets in the home. LPAs observed that a 3A40BC fire extinguisher, a functioning smoke detector, a carbon monoxide detector and a working telephone were present. Licensee was reminded to notify the Department before making any alterations or additions to the home and when any change from an area of the family child care home previously identified as off limits is changed to an area where care and supervision will be provided to children in care. Licensee states that a child will be isolated in the living room if necessary, due to illness or communicable disease until parent pick up. CONTINUED ON NEXT PAGE

Gladys Kuizon
Sara Mulugeta
	DATE: 09/16/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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Document Has Been Signed on 09/16/2026 03:08 PM - It Cannot Be Edited

Created By: Sara Mulugeta On 09/16/2026 at 02:02 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CLELAND, MICHELLE	FACILITY NUMBER: 444417940
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/16/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416(c)

Personnel Requirements

(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. Licensee and assistant did not have current pediatric CPR & fIrst aid certifications.
	POC Due Date: 09/30/2026
	Plan of Correction
1 2 3 4	Licensee will provide proof of completion of pediatric CPR and first aid certification to the LPA by the due date. Licensee will also submit plan of correction outlining how this issue will be prevented in the future.

Type B

Section Cited

HSC

1597.622(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. Assistant's file was missing measles immunization or proof of vaccination exemption,
	POC Due Date: 09/30/2026
	Plan of Correction
1 2 3 4	Licensee will provide proof of completion of assistant's measles vaccination or vaccination exemption to the LPA by the due date. Licensee will also submit plan of correction outlining how this issue will be prevented in the future.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Gladys Kuizon
NAME OF LICENSING PROGRAM MANAGER:

	Sara Mulugeta
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/16/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/16/2026 03:08 PM - It Cannot Be Edited

Created By: Sara Mulugeta On 09/16/2026 at 02:02 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CLELAND, MICHELLE	FACILITY NUMBER: 444417940
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/16/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(m)(3)

Operation of A Family Child Care Home

(3) A file of affidavits signed by each parent with a child enrolled in the home. The affidavit shall state that the parent has been informed that the family child care home does not carry liability insurance or a bond according to standards established by the state. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. Licensee did not obtain signed affidavit's regarding liability insurance and did not provide proof of current liability insurance coverage for the facility.
	POC Due Date: 09/21/2026
	Plan of Correction
1 2 3 4	Licensee will provide proof of current liability insurance coverage in the name of the facility or will provide affidavit's regarding liability insurance for all children enrolled by the due date. Licensee will also submit plan of correction outlining how this issue will be prevented in the future.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Gladys Kuizon
NAME OF LICENSING PROGRAM MANAGER:

	Sara Mulugeta
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/16/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2026

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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: CLELAND, MICHELLE	FACILITY NUMBER: 444417940
	VISIT DATE: 09/16/2026

NARRATIVE

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LPAs reviewed a current children's roster and fire drill log. Fire drill was last conducted on August 10, 2026, which is within the 6-month requirement for facilities. LPAs obtained a copy of the children's roster. LPAs reviewed a sample of five children’s files and observed all children’s files were missing the Affidavit Regarding Liability Insurance. Licensee does not have liability insurance for the day care. A Type B citation is on attached LIC 809-D.

LPAs reviewed Licensee and assistant's files for the required forms. Licensee and assistant’s CPR & First Aid expired May 2026. Licensee’s Mandated Reporter Certificate expires on March 19, 2027, and assistant’s Mandated Reporter expires on June 13, 2027. A review of records indicates that all employees have immunization records on file for pertussis and influenza declination. Assistant’s file is missing proof of measles vaccination. A Type B citation is on attached LIC 809-D.

LPAs discussed the safe sleep regulations with licensee, and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.

LPAs also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

CONTINUED ON NEXT PAGE

NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Sara Mulugeta
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/16/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2026

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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: CLELAND, MICHELLE	FACILITY NUMBER: 444417940
	VISIT DATE: 09/16/2026

NARRATIVE

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Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Supervision of children was discussed with Licensee and she understands that she or a qualified adult must be present in the home during day care hours and ensure that the children are supervised at all times. Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time and a qualified assistant must be present. Licensee understands in absence of a helper her license capacity is reduced to 8 and ratio (age of the children) must be observed.

Licensee understands that children's personal rights should not be violated; including no corporal punishment. Children have personal rights that cannot be waived or abridged regardless of consent or authorization from the child’s authorized representative. LPAs advised Licensee that children should not be left for extended periods of time in furniture such as a high chairs or cribs.

LPAs discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to resources such as forms, regulations, Provider Information Notices (PINs), and Quarterly Updates. LPAs discussed Reporting Requirements as outlined in the regulations (Section 102416.2).

LPAs discussed "zero tolerance" related regulations which includes the assessment of an immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. A $500 immediate civil penalty is assessed for serious violations such as absence of supervision, accessible bodies of water, accessible firearms, refused entry of licensing staff, presence of an excluded person, and violations that result in illness or injury. An ongoing civil penalty of $100 per day continues until the violation(s) is corrected.

CONTINUED ON NEXT PAGE

NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Sara Mulugeta
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/16/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2026

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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: CLELAND, MICHELLE	FACILITY NUMBER: 444417940
	VISIT DATE: 09/16/2026

NARRATIVE

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Licensee states Incidental Medical Services (IMS) are not provided. For IMS information see PIN 22-02-CCP. Licensee stated that no children require medications or IMS at this time. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Licensee does not transport any day care children. LPAs reminded Licensee that if she decides to transport children, children should not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California. Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPAs completed the RSO profile in FAS.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

During today's inspection, three "Type B" deficiencies are issued on attached 809-D. Appeal rights provided. LPAs reviewed report with Licensee.

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

---END OF REPORT---

NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Sara Mulugeta
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/16/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2026

LIC809 (FAS) - (06/04)

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