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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483008509
Report Date: 01/25/2024
Date Signed: 02/09/2024 06:51:36 AM

Document Has Been Signed on 02/09/2024 06:51 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:GREEN, ROBIN FCCHFACILITY NUMBER:
483008509
ADMINISTRATOR:GREEN, ROBINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 980-6002
CITY:VALLEJOSTATE: CAZIP CODE:
94589
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
01/25/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:TIME COMPLETED:
08:45 AM
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LPA Ouye arrived to conduct an annual inspection. The person behind the security screen front door said that they recently moved in and there is no Robin Green that lives here. She thinks it was probably the person that moved out,
LPA Ouye has tried to call Robin Green several times and was only able to leave messages. Robin Green did send a change of address to CCLD however the new address is a mail box at a strip mall and not a physical address.

Licensee unavailable for signature.

LPA Ouye will mail new address with notification of closure because there is no physical site based location.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 01/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/25/2024
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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