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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483009330
Report Date: 05/14/2024
Date Signed: 06/19/2024 02:47:31 PM

Document Has Been Signed on 06/19/2024 02:47 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:WARD, MELINDA FCCHFACILITY NUMBER:
483009330
ADMINISTRATOR/
DIRECTOR:		WARD, MELINDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 400-7886
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
05/14/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:50 PM
MET WITH:No oneTIME VISIT/
INSPECTION COMPLETED:
03:05 PM
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Licensing Program Analyst (LPA) Elpidia Hernandez Torres arrived to the home to conduct a case management visit and ask about the status of the day care. The annual fees for the license are past due, second notice was sent out on 05/01/24 requesting fees paid on or before 05/15/24. If payment is not received by 05/15/24 license maybe forfeited and facility will be closed.

Upon arriving LPA saw a 'for sale sign' with a realtor name and number. There was no vehicle parked in the drive way. LPA rang the door bell to the home, there was no answer. LPA called the number for the realtor and asked about the property. Realtor reported the property is on the market and for sale.

This facility is closed permanently as of 05/14/2024.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE: DATE: 05/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/14/2024
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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