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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274405599
Report Date: 03/09/2022
Date Signed: 03/09/2022 01:59:58 PM

Document Has Been Signed on 03/09/2022 01:59 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:LUNA, DELFINA M.FACILITY NUMBER:
274405599
ADMINISTRATOR:DELFINA M LUNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 449-8517
CITY:SALINASSTATE: CAZIP CODE:
93906
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
03/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Delfina LunaTIME COMPLETED:
02:15 PM
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On 03/09/2022 at 01:20 PM, Licensing Program Analyst (LPA) Susy Cervantes, met with licensee, Delfina Luna, for an annual inspection and explained the reason for the visit to them. Present during today's visit was licensee and their spouse.

LPA was unable to conduct an annual inspection because the house had recently suffered water damage (October 2021) and is currently being repaired. Licensee stated they had mailed a letter with a copy of their license to inform they would be inactive while the house is being repaired. LPA provided licensee with an inactive form and a new application to update their phone number, Licensee completed the forms during the visit.

No deficiencies were cited during today's visit. Exit interview conducted and report reviewed with licensee, Delfina Luna. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Susy Cervantes
LICENSING EVALUATOR SIGNATURE: DATE: 03/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/09/2022
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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