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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 480110456
Report Date: 09/13/2023
Date Signed: 09/13/2023 09:09:19 AM

Document Has Been Signed on 09/13/2023 09:09 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: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:
09/13/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Valerie Bosson - LicenseeTIME COMPLETED:
09:25 AM
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Licensing Program Analyst (LPA), Melchisedeck Augustin made an unannounced Case Management visit and met with Licensee (LS), Valerie Bosson, for the purpose of following up on several deficiencies. The Department made multiple attempts to reach LS, however; LS did not respond. The facility is currently on inactive status which expired on 03/06/22 and on 08/15/23, the Department evaluated the facility for compliance with Title 22 and determined that several items needed to be corrected. During today's visit, LPA did not observe any children in care, and LS had not corrected the deficiencies.

LPA advised LS that the facility had three options which included correcting the deficiencies and reopening or extending the facility's inactive status until 03/07/24 or close the facility. LS completed and submitted an LIC 9211 and agreed to extend the facility's inactive status from 09/13/23 until 02/13/24. LS understood that the facility may be placed on inactive status for up to 12 months, and the inactive status may only be extended through the facility's anniversary date. The Licensee also understood she may request the facility status be changed from inactive status to licensed status, however; the facility is subject to an inspection prior to being placed on licensed status. This report was reviewed and discussed with LS.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE: DATE: 09/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/13/2023
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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