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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
274409648
Report Date:
04/27/2022
Date Signed:
07/28/2022 04:56:09 PM
COMPREHENSIVE INSPECTION
Document Has Been Signed on
07/28/2022 04:56 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:
GOMEZ, ROSEMARY
FACILITY NUMBER:
274409648
ADMINISTRATOR:
ROSEMARY GOMEZ
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(831) 444-7793
CITY:
SALINAS
STATE:
CA
ZIP CODE:
93906
CAPACITY:
14
TOTAL ENROLLED CHILDREN:
14
CENSUS:
DATE:
04/27/2022
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
02:35 PM
MET WITH:
TIME COMPLETED:
03:20 PM
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SUPERVISORS NAME
:
Joel Segura
LICENSING EVALUATOR NAME
:
Elizabeth Larios
LICENSING EVALUATOR SIGNATURE
:
DATE:
04/27/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
04/27/2022
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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