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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 480110456
Report Date: 08/02/2023
Date Signed: 08/02/2023 03:12:50 PM

Document Has Been Signed on 08/02/2023 03:12 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:BOSSON, VALERI J. FCCHFACILITY NUMBER:
480110456
ADMINISTRATOR:BOSSON, VALERI J.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 631-3997
CITY:SUISUNSTATE: CAZIP CODE:
94585
CAPACITY: 9TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/02/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:Valerie Bosson - LicenseeTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA), Melchisedeck Augustin made an unannounced Case Management visit and met with Licensee, Valeri Bosson (LS) in response to the facility's outstanding annual fee of $210 which was due on 03/06/2023 and inactive status which expired on 03/06/2022. During today's visit, there were zero children in care and LS conveyed interest in extending the facility's inactive status, and LS paid her fee in full. LS further expressed she would like the facility to reopen and provided a completed licensing form 9211 to request the facility license be placed on inactive status from 08/02/23 through 08/16/23. LS understood that prior to reopening the facility, the Department is required to conduct a follow up inspection to ensure the facility is in compliance with Title 22, as well Health and Safety Code law.

LS understood she was allowed to provided care only in accordance with License exemption of California Code of Regulations (CCR) 102358, which indicated that the provider may provide care for her own children and for the children of one family. This report was discussed and reviewed with the Licensee, Valeri Bosson.
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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