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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 445201410
Report Date: 09/09/2022
Date Signed: 09/09/2022 11:57:00 AM

Document Has Been Signed on 09/09/2022 11:57 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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:PAJARO VALLEY TRAINING CENTERFACILITY NUMBER:
445201410
ADMINISTRATOR:MAUNA MORRISFACILITY TYPE:
775
ADDRESS:14 CARR STREETTELEPHONE:
(831) 761-8628
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY: 49CENSUS: 13DATE:
09/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Mauna MorrisTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) David Marrufo and Licensing Program Manager (LPM) Cara Smith conducted an unannounced Required 1 Year visit and met with Administrator Mauna Morris.

During visit, LPA Marrufo and LPM Smith toured the inside and outside of the facility. A visitor screening area was observed. The bathrooms were observed to contain available soap and paper towels and had hand washing signs. A PPE supply of at least 30 days was observed. Cleaning supplies were observed in the facility.

An Advisory Note was issued. See LIC9102 for additional information.

No deficiencies were cited as per California Code of Regulations Title 22.

This report was reviewed with Administrator Mauna Morris and a copy of the report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE: DATE: 09/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/09/2022
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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