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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483005218
Report Date: 06/11/2024
Date Signed: 06/11/2024 02:11:02 PM

Document Has Been Signed on 06/11/2024 02:11 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/
DIRECTOR:		GARY, MARIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 208-1381
CITY:SUISUNSTATE: CAZIP CODE:
94585
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
06/11/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:25 PM
MET WITH:Marie Gary - LicenseeTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA), Melchisedeck Augustin made an unannounced Case Management visit for the purpose of conducting an Annual/Random inspection, however; upon arrival, the Licensee, Marie Gary (LS) expressed interest in forfeiting the facility license. According to LS, she had not had any enrollee(s) since the end of February 2024 and due to personal reasons, LS was no longer interested in operating a childcare facility, and as such; LS opted to forfeit her facility license. LS did not locate her original license, but she did submit a written statement reflecting she was no longer interested in operating a childcare facility. During today's visit, there were zero children in care and there was no childcare equipment setup. LS allowed LPA to take a tour of the facility on limits areas and based on observations, there was no evidence to suggest that an active childcare facility being operated on the premise.

LPA provided copies of California Code of Regulations (CCR) 102358, 102383, and Health and Safety Code 1596.858 and consulted with LS on license exemptions of California Code of Regulations (CCR) 102358 and 102383, which, indicated that the provider may provide care for her own children and for the children of one family. The facility license is forfeited in accordance with CCR 102383(a)(1), and the license will be closed effective, 06/11/2024. This report was discussed and reviewed with Licensee, Marie Gary.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE: DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/11/2024
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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