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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430751182
Report Date: 08/12/2022
Date Signed: 08/12/2022 03:11:17 PM

Document Has Been Signed on 08/12/2022 03:11 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:BROWN, ANN & LYNNFACILITY NUMBER:
430751182
ADMINISTRATOR:BROWN, ANNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 374-6612
CITY:CAMPBELLSTATE: CAZIP CODE:
95008
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/12/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Ann BrownTIME COMPLETED:
03:20 PM
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Licensing Program Analyst (LPA), James Santos conducted an unannounced Required 1 Year Inspection visit today and met with Licensee, Ann Brown.

The daycare home currently does not have any daycare children. Per Licensee, they have not operated their daycare home since the start of COVID-19 pandemic in 2020, and eventually decided they are no longer interested in keeping their license.

During today's visit, LPA advised Licensee to write a letter to the Department that they are no longer interested in keeping their family daycare home license.

Licensee agreed and wrote the letter and provided the letter to LPA. LPA advised Licensee that the closure of their family daycare home license will be processed and the closure letter will be mailed to their mailing address.


No deficiencies cited. Exit interview conducted and report was reviewed and a copy of was provided to Licensee.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: James G Santos
LICENSING EVALUATOR SIGNATURE: DATE: 08/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/12/2022
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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