<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483010549
Report Date: 05/02/2024
Date Signed: 05/02/2024 01:10:03 PM

Document Has Been Signed on 05/02/2024 01:10 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:JOHNSEN, JESSICA FCCHFACILITY NUMBER:
483010549
ADMINISTRATOR/
DIRECTOR:		JOHNSEN, JESSICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 362-7322
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
05/02/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Licensee Jessica JohnsonTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst ( LPA) Elpidia Hernandez Torres arrived to the family child care home at 12:45PM to conduct a case management visit. Licensee had called LPA to request to close permanently. Licensee reported she notified families of enrolled children on April 1st 2024 that she was going to be closing permanently as of April 30th 2024. The last day children were in care was on April 30th 2024. LPA arrived to the facility and did not observe any day care children present. There was no indication of day care being provided, most day care furniture has begun to be packed away.

This Family child care home is permanently closed as of 04/30/2024.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE: DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/02/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1