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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173009178
Report Date: 11/30/2022
Date Signed: 11/30/2022 01:39:53 PM

Document Has Been Signed on 11/30/2022 01:39 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:STOUT, JULES FCCHFACILITY NUMBER:
173009178
ADMINISTRATOR:STOUT, JULESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 766-4592
CITY:COBBSTATE: CAZIP CODE:
95426
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
11/30/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:TIME COMPLETED:
01:40 PM
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On 11/30/2022, at 12:50PM, Licensing Program Analyst, Sebastian Phouthavong made an unannounced Case Management visit to the facility to verify operation at the facility, and to address the facility's forfeiture. Prior to visit, LPA spoke with Licensee, Jules Stouts, and informed LPA of closure 11/29/2022. No resident was available at the time of visit.

During the visit, LPA toured the home’s front yard and observed no children in care. There were no evidence of operation and/or childcare being provided at the facility. Licensee stated she currently working for the School District and nobody is home during most of the day. Once requested documents are submitted to CCL, the approval the Closure for the Family Child Care Home will be met.


Facility Representative Signature not available at this time.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2022
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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