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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 480110456
Report Date: 03/20/2024
Date Signed: 03/20/2024 02:21:51 PM

Document Has Been Signed on 03/20/2024 02:21 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:
03/20/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:05 PM
MET WITH:Valeri Bosson - LicenseeTIME COMPLETED:
02:30 PM
NARRATIVE
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Licensing Program Analyst (LPA), Melchisedeck Augustin made an unannounced Case Management visit and met with the Licensee, Valeri Bosson, for the purpose of addressing the facility's inactive status which expired on 02/13/24 and outstanding fee of $140 that was due by 03/07/24. During today's visit, there were no children in care and LPA did not see evidence of child care operation occurring at the facility. According to the Licensee, she mailed a statement to request the closure of her license approximately one month ago. During the visit, the Licensee produced and submitted a written a statement indicating she was no longer interested in operating a child care facility, and forfeited the facility license, effective, 03/20/24.

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, 03/202024. This report was discussed and reviewed with the Licensee, Valeri Bosson.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE: DATE: 03/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/20/2024
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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