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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 445202230
Report Date: 10/11/2022
Date Signed: 10/11/2022 02:38:01 PM

Document Has Been Signed on 10/11/2022 02:38 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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:CASA PACIFICFACILITY NUMBER:
445202230
ADMINISTRATOR:ERIN MCLAUGHLINFACILITY TYPE:
772
ADDRESS:321 E. BEACH STREETTELEPHONE:
(831) 459-0444
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY: 12CENSUS: 9DATE:
10/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Serina CheeTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Serina Chee.

During visit, LPA Marrufo toured the facility inside and out. LPA Marrufo observed the facility to have a visitor screening area at the entrance. LPA Marrufo observed the bathrooms to have available soap, paper towels, and hand washing signs. A PPE supply of at least 30 days was observed. A perishable food supply of at least 2 days and a non-perishable food supply of at least 7 days were observed.

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

This report was reviewed with Serina Chee and a copy of the report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE: DATE: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/11/2022
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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