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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 065406412
Report Date: 12/13/2023
Date Signed: 12/13/2023 11:51:56 AM

Document Has Been Signed on 12/13/2023 11:51 AM - 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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:GUZMAN, YESENIA FAMILY CHILD CARE HOMEFACILITY NUMBER:
065406412
ADMINISTRATOR:GUZMAN, YESENIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 701-0313
CITY:WILLIAMSSTATE: CAZIP CODE:
95987
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
12/13/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:28 AM
MET WITH:Yesenia GuzmanTIME COMPLETED:
11:55 AM
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On 12/13/2023 at 11:20am LPA Laura Chavez conducted a case management visit to the home and met with Licensee Yesenia Guzman. The visit was made due to the licensee's inactive licensee having expired.

During today's visit LPA obtained a completed and signed Request For Inactive Child Care License Status LIC9211 in order to continue to keep the licensee's license inactive.

All licensing reports are public information and must be made available upon request for at least three years

An exit interview was conducted,and a Notice of Site Visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Laura Chavez
LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2023
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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