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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
274405377
Report Date:
02/16/2022
Date Signed:
02/18/2022 09:56:54 AM
COMPREHENSIVE INSPECTION
Document Has Been Signed on
02/18/2022 09:56 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
CCLD Regional Office
,
2580 N FIRST STREET, STE. 300
SAN JOSE
,
CA
95131
FACILITY NAME:
SANCHEZ, HILDA T
FACILITY NUMBER:
274405377
ADMINISTRATOR:
SANCHEZ, HILDA T
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(831) 763-1097
CITY:
WATSONVILLE
STATE:
CA
ZIP CODE:
95076
CAPACITY:
14
TOTAL ENROLLED CHILDREN:
0
CENSUS:
DATE:
02/16/2022
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
10:00 AM
MET WITH:
Hilda Sanchez
TIME COMPLETED:
10:27 AM
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SUPERVISORS NAME
:
Joel Segura
LICENSING EVALUATOR NAME
:
Cortney Nelson
LICENSING EVALUATOR SIGNATURE
:
DATE:
02/16/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
02/16/2022
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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