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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274407705
Report Date: 02/24/2022
Date Signed: 02/24/2022 03:33:50 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 02/24/2022 03:33 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:GARCIA, YADIRAFACILITY NUMBER:
274407705
ADMINISTRATOR:GARCIA, YADIRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 771-1073
CITY:SALINASSTATE: CAZIP CODE:
93901
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
02/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Yadira GarciaTIME COMPLETED:
03:35 PM
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Licensing Program Analyst (LPA) Joe Macias attempted to conducted an unannounced Annual Random Inspection. The purpose of today’s inspection is to ensure the home is in compliance with Title 22 California Code of Regulations. LPA was greeted and granted entrance by the Licensee Yadira Garcia. Upon arrival the Licensee explained that she is unsure she would like to continue to maintain a license.

LPA Macias explained the inactive status process, as well as unlicensed care. During today's inspection the Licensee submitted a letter of closure. LPA Macias explained that she would receive a forfeiture letter as a formality.





No deficiencies cited, exit interview conducted, and a copy of this report was provided to the Licensee.


SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Joseph Macias
LICENSING EVALUATOR SIGNATURE: DATE: 02/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/24/2022
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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