Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444410144
Report Date: 05/02/2019
Date Signed: 05/02/2019 03:44:39 PM

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:CHAVEZ, ESTHERFACILITY NUMBER:
444410144
ADMINISTRATOR:ESTHER CHAVEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 722-8622
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:14CENSUS: 8DATE:
05/02/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Esther ChavezTIME COMPLETED:
03:50 PM
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An unannounced random visit made by Mahvash Behbood. Met licensee Ester Chavez, purpose of the visit explained. Present also were 8 day care children including 2 infants and one school age. Days and hours of operation is M through F from 6 AM to 6 PM. Inside and outside of the home inspected. children and staff file reviewed. Living at the home are licensee and her husband when he is not in Mexico.
There are no bodies of water on the property.
Licensee stated there are no gun at home.
Cleaning supplies stored inaccessible to children.
No fire place in day care area. Fire extinguisher is the correct size. Smoke and carbon monoxide are operational.
Toys and play equipment are safe and age appropriate.
Telephone is working and the phone number is still the same.
Children were supervised during the visit.
Discussed with licensee children are not to be left in parked vehicles.
Backyard where children play is fenced.
Licensee's roster was up to date. There is emergency information on file for all children in care.
The last fire/disaster drill conducted is on 01/2019 and is documented on a log.
The adults who live in the home and all staff have fingerprint clearance.
CPR and First Aid is expired on 02/02/2021. Staff are current with their immunization records.
Children are not on any medication.
Off limits: Garage, one side yard, 2 shed located beyond the 3 feet fence.
No deficiency noted during today's visit
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Mahvash BehboodTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2019
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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