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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173010140
Report Date: 02/05/2024
Date Signed: 02/05/2024 09:18:15 AM

Document Has Been Signed on 02/05/2024 09:18 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:HECKARD, JASMINE FCCHFACILITY NUMBER:
173010140
ADMINISTRATOR:JASMINE HECKARDFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 533-5214
CITY:LAKEPORTSTATE: CAZIP CODE:
95453
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
02/05/2024
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jasmine HeckardTIME COMPLETED:
09:30 AM
NARRATIVE
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On 02/05/2024, at 9:00AM, Licensing Program Analyst, Sebastian Phouthavong made an announced Case Management visit to the facility and met with Licensee, Jasmine Heckard to verify operation at the facility, and to address the facility's forfeiture. Prior to visit, on 01/04/2024, Licensee notified LPA on the forfeiture.

During the visit, LPA observed no children in care and toured the room of where care was being provided. There was no evidence of operation and/or childcare being provided at the facility. Licensee stated she has cease operation due to be moving out of the area and is no longer interested on providing care. LPA received a copy of the license with Licensee’s signature and date of closure. The approval the Closure for the Family Child Care Home has been met.

Exit interview conducted and report was reviewed with the licensee, Jasmine Heckard.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE: DATE: 02/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/05/2024
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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