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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483008103
Report Date: 04/08/2022
Date Signed: 04/08/2022 02:27:08 PM

Document Has Been Signed on 04/08/2022 02:27 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:RICHMOND, CANDICE FCCHFACILITY NUMBER:
483008103
ADMINISTRATOR:RICHMON, CANDICEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 419-1410
CITY:VALLEJOSTATE: CAZIP CODE:
94590
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
04/08/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Licensee unavailableTIME COMPLETED:
02:35 PM
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Licensing Program Analysts (LPAs), Melchisedeck Augustin and Sebastian Phouthavong made an attempted unannounced Case Management visit to the facility to verify operation at the facility, and to address the facility's outstanding annual fee of $420. On 04/08/22, LPAs reviewed Department records which confirmed the facility still had an outstanding balance of $420 and the fee was not current. During today's inspection, LPAs knocked on the facility front entry door and the Licensee (LS) did not answer the door and was not present at the facility. LPAs did not see any indications that the facility had not been in operation for quite some time. There was a large curtain covering the window, lights were turned off inside the facility, there were no sound of activities being heard from within the facility; and there was no evidence of operation and/or childcare being provided at the facility. The Department made several prior attempted visits and calls to LS, however; LS was unresponsive. An interview with a neighbor (A1) revealed that A1 had not seen any activities at the facility beyond the occasional clean-up, and, A1 claimed that approximately two to three months ago; A1 saw a pile of preschool items which consisted of toys, easels, etc. was put out on trash collection day for dumping. Due to indications of none-operation at the facility, the facility license is forfeited in accordance with California Code of Regulations, 102383(a)(1), effective, 04/08/22. The Licensee was unavailable for signature.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE: DATE: 04/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/08/2022
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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