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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483009066
Report Date: 06/10/2022
Date Signed: 06/10/2022 09:04:11 AM

Document Has Been Signed on 06/10/2022 09:04 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:SPEER, JESSIKA FCCHFACILITY NUMBER:
483009066
ADMINISTRATOR:SPEER, JESSIKAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 642-6877
CITY:VALLEJOSTATE: CAZIP CODE:
94592
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
06/10/2022
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
08:24 AM
MET WITH:Jessica SpeerTIME COMPLETED:
09:15 AM
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Licensing Program Analyst (LPA), Melchisedeck Augustin made an announced Case Management visit to verify operation status of the facility. On 06/06/22, the Licensee forfeited the facility license with written statement reflecting her request to close the facility. During today's visit, LPA met with Licensee, Jessica Speer (LS) and toured the facility indoor and outdoor on limit areas. There was no indication that a childcare facility was being operated in the home and LPA did not see any daycare children in the home. LPA consulted on license exemptions of California Code of Regulations (CCR) 102358 and 102383 and provided a copy of the regulations to LS. LS appeared to have acknowledged the regulations and understood she could provide exempt care which included providing care to her own children and for the children of one family. The facility license is forfeited in accordance with California Code of Regulations (CCR) 102383(a)(1), and the license will be closed effective, 06/10/2022. This report was reviewed and discussed with LS.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE: DATE: 06/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/10/2022
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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