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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483005218
Report Date: 01/03/2023
Date Signed: 01/03/2023 12:39:45 PM

Document Has Been Signed on 01/03/2023 12:39 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:GARY, MARIE FAMILY CHILD CARE HOMEFACILITY NUMBER:
483005218
ADMINISTRATOR:GARY, MARIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 208-1381
CITY:SUISUNSTATE: CAZIP CODE:
94585
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
01/03/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Licensee Marie GaryTIME COMPLETED:
12:45 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 (LPAs) Melchisedeck Augustin and Elpidia Hernandez Torres arrived to the facility to conduct a case management and verify status of the daycare. Licensee previously emailed LPA Hernandez Torres on 11/21/2022 stating the day care would close 12/23/2022. LPA emailed licensee back on 12/07/2022 asking if it would be a temporary closure or a permanent closure and the items required for each. Licensee did not email LPA back. LPA called licensee on 12/28/2022 there was no option to leave a voice message.

Upon arrival LPA Augustin discussed the options for closure, there is temporary closure or permanent closure. If licensee chooses to close permanent then they surrender their license and no longer will have a Family Child Care Home. The temporary closure is called " in-active" where a licensee can close for up to a year and agree to certain conditions. Licensee stated she chooses to close temporarily. LPA Augustin printed our LIC 9211 and filled it out with licensee. Licensee wishes to go in-active from 01/03/2023- 10/02/2023 and agrees to the following:
a. I will not provide child care for which a license is required until my license is reactivated.
b. I will continue to promptly pay the annual license fee.
c. I will inform your office of any changes in the above dates prior to
re-opening my facility by submitting a new LIC 9211.
d. I will be in compliance with all licensing laws and regulations upon
re-opening my facility, including but not limited to:
● Ensuring all adult staff and residents, including children who turn 18
during the inactive period, have criminal record clearances
● Maintaining current CPR and First Aid certifications
● Maintaining a current fire extinguisher and functioning smoke alarms

Continued on 809-C
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE: DATE: 01/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/03/2023
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: GARY, MARIE FAMILY CHILD CARE HOME
FACILITY NUMBER: 483005218
VISIT DATE: 01/03/2023
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
26
27
28
29
30
31
32
LPAs also printed and review regulation 102358 license exempted care, where licensee can care for one other families' children aside from her own without a a license. LPAs reminded licensee if she wishes to go back to active sooner than 10/02/2023 she is required to contact the department and a back to active inspection will be conducted.

This facility is in-active 01/03/2023-10/02/2023. Notice of Site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with licensee.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2