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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 480110249
Report Date: 08/02/2023
Date Signed: 08/02/2023 01:26:53 PM

Document Has Been Signed on 08/02/2023 01:26 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:BANZET, PHUOC FAMILY CHILD CARE HOMEFACILITY NUMBER:
480110249
ADMINISTRATOR:BANZET, PHUOCFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 449-0714
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 13DATE:
08/02/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Phuoc Banzet - LicenseeTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA), Melchisedeck Augustin made an unannounced visit for the purpose of conducting a Required 1-Year inspection, however; upon arrival, the Licensee, Phuoc Banzet (LS) forfeited the facility license. LS expressed she was no longer interested in operating a childcare facility and as such, LS opted to forfeit her facility license. LS submitted the original license with a written statement reflecting she was no longer interested in operating a childcare facility. During today's visit, LPA observed 13 children including a child under 24 months old in care with Licensee and one staff (S1), and a follow up visit is required to verify the facility's operational status.

LPA provided copies of California Code of Regulations (CCR) 102358 and 102383 and consulted with LS on license exemptions of California Code of Regulations (CCR) 102358 and 102383, which, indicated that the provider may provide care for her own children and for the children of one family. The facility license is forfeited in accordance with CCR 102383(a)(1), and the license will be closed effective, 08/042023. This report was discussed and reviewed with LS.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE: DATE: 08/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/02/2023
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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