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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173010163
Report Date: 11/21/2022
Date Signed: 11/21/2022 11:08:34 AM

Document Has Been Signed on 11/21/2022 11:08 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:WICHLAZ, HEATHER FCCHFACILITY NUMBER:
173010163
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
11/21/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Heather WichlazTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Glenn Ouye met with licensee, Heather Wichlaz to conduct a capacity increase. The Kelseyville, fire inspector on Tuesday, November 15, 2022. He verbally gave the licensee the approval and indicated that he would be sending the fire clearance to CCLD.

The home has a functioning smoke and carbon monoxide detector. The fire extinguisher in the hallway near the main entrance.

Upon receipt of the approved fire clearance the facility will be approved as a large family child care home.

No deficiencies during the visit.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 11/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2022
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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