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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173009408
Report Date: 12/06/2024
Date Signed: 12/06/2024 10:58:35 AM

Document Has Been Signed on 12/06/2024 10:58 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:WALSTON, BRITTANY FCCHFACILITY NUMBER:
173009408
ADMINISTRATOR/
DIRECTOR:		WALSTON, BRITTANYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 703-9946
CITY:UPPER LAKESTATE: CAZIP CODE:
95485
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
12/06/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Brittany WalstonTIME VISIT/
INSPECTION COMPLETED:
09:45 AM
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On 12/06/2024 at 09:20AM, Licensing Program Analyst, Sebastian Phouthavong made an unannounced Case Management visit to the facility and met with Licensee, Brittany Walston regarding the facility's Inactive status and annual fees.

During the visit, LPA observed no children in care. Licensee requested to continue her inactive status and was informed that all fees must be paid before continuing her inactive status.

The approval the the inactive status will be completed once annual fees are current.

Exit interview conducted and report was reviewed with Licensee, Brittany Walston.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE: DATE: 12/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/06/2024
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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