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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444410974
Report Date: 08/31/2023
Date Signed: 09/11/2023 11:49:36 AM

Document Has Been Signed on 09/11/2023 11:49 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:HERNANDEZ, OLGAFACILITY NUMBER:
444410974
ADMINISTRATOR:OLGA HERNANDEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 840-1423
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
08/31/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Olga HernandezTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Elizabeth Berumen conducted a case management visit to the home today. Also present in the home was Licensee's son, Christopher (assistant) and six day care children.

Purpose of todays inspection is to grant approval for a room previously listed as off limits to on limits. LPA inspected the entire home; off limit areas are two bedrooms and hall closets.


No deficiency cited
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE: DATE: 08/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2023
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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