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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483009938
Report Date: 03/27/2024
Date Signed: 03/27/2024 10:09:39 AM

Document Has Been Signed on 03/27/2024 10:09 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:OBIEDO, TERESA FCCHFACILITY NUMBER:
483009938
ADMINISTRATOR:OBIEDO, TERESAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 342-7631
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
03/27/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Teresa ObiedoTIME COMPLETED:
10:00 AM
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Licensing Program Analyst Glenn Ouye met with licensee Teresa Obiedo who has moved out of her home on March 20, 2024. She has moved in with her son and will be a co-licensee with her son.

Ms. Obiedo will at some point move into another home and will be re-licensed at the new location.

LPA met with the new renter at 391 Clydesdale.

LPA Ouye will process the closure effective March 20 2024.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/27/2024
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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