Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444410144
Report Date: 02/23/2018
Date Signed 02/23/2018 12:09:06 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: 6DATE:
02/23/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Esther ChavezTIME COMPLETED:
12:25 PM
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An unannounced random visit made by Mahvash Behbood. Met licensee Ester Chaves, purpose of the visit explained. Present also were 6 day care children two of which under 2 years old, at the rest between 2 and 5. 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.
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. Licensee states the heater and air conditioner work properly.
No stairs
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 fire/disaster drill are documented and up to date.
The adults who live in the home and all staff have fingerprint clearance.
CPR and First Aid is expired on 03/2019 . Staff are current with their immunization records.
Incidental Medical Services were discussed with the licensee. The licensee is not providing IMS (Incidental Medical Services) at this time. Licensee will submit an updated plan of operation if in the future they provide any IMS services to a child in care.
Off limits: Garage, one side yard.
No deficiency noted during today's visit
SUPERVISOR'S NAME: Timetra FaulconTELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Mahvash BehboodTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2018
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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