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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493008314
Report Date: 01/13/2022
Date Signed: 01/18/2022 09:34:44 AM

Document Has Been Signed on 01/18/2022 09:34 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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:ALVAREZ, CRYSTALFACILITY NUMBER:
493008314
ADMINISTRATOR:ALVAREZ, CRYSTALFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 569-6105
CITY:WINDSORSTATE: CAZIP CODE:
95492
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
01/13/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:12 PM
MET WITH:Crystal AlvarezTIME COMPLETED:
02:28 PM
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Licensing Program Analyst (LPA), Y. Yang conducted an unannounced Case Management visit to verify closure of the facility. The LPA observed that the lights were off inside the home and there was no evidence of childcare being provided at this address. The former licensee was unavailable for a signature. The licensee notified the LPA by telephone that she was currently at her new place of employment. The facility license was forfeited effective 01/11/22.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Yang Yang
LICENSING EVALUATOR SIGNATURE: DATE: 01/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/13/2022
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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