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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483005603
Report Date: 09/19/2022
Date Signed: 09/21/2022 04:33:52 PM

Document Has Been Signed on 09/21/2022 04:33 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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:GUTIERREZ, ALISHA FAMILY CHILD CARE HOMEFACILITY NUMBER:
483005603
ADMINISTRATOR:GUTIERREZ, ALISHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 678-8561
CITY:DIXONSTATE: CAZIP CODE:
95620
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
09/19/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Alisha GutierrezTIME COMPLETED:
02:50 PM
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A case management visit was conducted on 9/19/2022 at 2:35pm by Licensing Program Analyst's (LPA's), Laura Chavez and Erica Laird. LPA's met with Licensee Alisha Gutierrez. Licensee Alisha Gutierrez informed LPA's Chavez and Laird that she is no longer providing care and supervision to children and requested that her file be closed. During todays visit the licensee surrendered her license to LPA's.

This report was reviewed and discussed with licensee Alisha Gutierrez.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Laura Chavez
LICENSING EVALUATOR SIGNATURE: DATE: 09/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2022
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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