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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 233010483
Report Date: 11/27/2024
Date Signed: 11/27/2024 10:17:09 AM

Document Has Been Signed on 11/27/2024 10:17 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 CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:MYERS, KATHRYN FCCHFACILITY NUMBER:
233010483
ADMINISTRATOR/
DIRECTOR:		MYERS, KATHRYNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 357-1068
CITY:LAYTONVILLESTATE: CAZIP CODE:
95454
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
11/27/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:47 AM
MET WITH:Kathryn MyersTIME VISIT/
INSPECTION COMPLETED:
10:28 AM
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On 11/27/2024 Licensing Program Analyst (LPA) Robert Maciel arrived at the facility to conduct a confirmation of closure visit. On 9/26/2024 Licensee contacted the LPA in regards to requests to pay her licensing fee. Licensee stated that she had submitted a form to the department stating her intent to cease operation as of 6/1/24.

During today’s visit LPA did not see or hear day care children in the home. It does not appear that care is being provided. Licensee provided LPA with her license. LPA provided Licensee a confirmation of closure receipt.

Effective, 06/01/24 facility #233010483 is no longer licensed and can no longer provide licensed care to children.

SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Robert Maciel
LICENSING EVALUATOR SIGNATURE: DATE: 11/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/27/2024
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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