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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
483004110
Report Date:
07/10/2024
Date Signed:
07/10/2024 09:25:03 AM
Document Has Been Signed on
07/10/2024 09:25 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
SANTA ROSA RO
,
1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA
,
CA
95405
FACILITY NAME:
PAGUIO, LILIAN FCCH
FACILITY NUMBER:
483004110
ADMINISTRATOR/
DIRECTOR:
PAGUIO, LILIAN
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(707) 631-0347
CITY:
FAIRFIELD
STATE:
CA
ZIP CODE:
94534
CAPACITY:
14
TOTAL ENROLLED CHILDREN:
14
CENSUS:
0
DATE:
07/10/2024
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
09:05 AM
MET WITH:
TIME VISIT/
INSPECTION COMPLETED:
09:25 AM
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LPA made an unannounced case management visit to conduct a confirmation of closure. LPA knocked on door three separate times with no answer. LPA attempted to call the Licensee with no answer. There were no cars in the driveway or on street in front of the home. LPA did not hear any noises coming from inside the home or in the backyard. It does not appear that care is being provided.
Multiple attempts have been made to contact the Licensee with no response.
Confirmation of facility closure is complete. Facility will be closed as of today 07/10/2024.
SUPERVISORS NAME
:
Leslie Lepori
LICENSING EVALUATOR NAME
:
Melinda Mohr
LICENSING EVALUATOR SIGNATURE
:
DATE:
07/10/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
07/10/2024
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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