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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444415945
Report Date: 09/10/2024
Date Signed: 09/10/2024 12:33:20 PM

Document Has Been Signed on 09/10/2024 12:33 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:VASQUEZ-NAREZ, ANA MARIAFACILITY NUMBER:
444415945
ADMINISTRATOR/
DIRECTOR:		ANA MONTESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 254-7878
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
09/10/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:06 PM
MET WITH:Ana Maria Vasquez-NarezTIME VISIT/
INSPECTION COMPLETED:
12:36 PM
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Licensing Program Analyst (LPA) Teodoro Trujillo conducted an unannounced case management inspection to the home today. LPA met with licensee Ana Maria Vasquez-Narez. Licensee was providing care to four children today including two infant and two preschoolers. Present with licensee was assistant Brenda and licensee 15 year old child. LPA reviewed children's roster and observed roster has been updated today.

Due to a site visit on 06/20/24, and children interviews, Licensee was provided with Technical Assistance with CCR 102416.3(a)(6) Alterations to Existing Buildings or Grounds and 102425 Infant Sleep.

No Deficiencies were cited during today's visit.

Exit interview conducted and report was reviewed with the licensee Ana Maria Vasquez-Narez.

A notice of Site inspection was printed and licensee was instructed to post it for 30 consecutive days.
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE: DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2024
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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