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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483009633
Report Date: 09/09/2022
Date Signed: 09/09/2022 01:30:15 PM

Document Has Been Signed on 09/09/2022 01:30 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:SEDIQI, ROHEENA FCCHFACILITY NUMBER:
483009633
ADMINISTRATOR:SEDIQI, ROHEENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 999-6699
CITY:FAIRIELDSTATE: CAZIP CODE:
94534
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
09/09/2022
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
10:03 AM
MET WITH:Roheena SediqiTIME COMPLETED:
11:49 AM
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Licensing Program Analyst (LPA), Y. Yang made an unannounced Case Management – Legal/Non-Compliance visit to the facility and met with Licensee, Roheena Sediqi for the purpose of ensuring compliance with the terms of the Stipulation or Decision and Order. Per the Decision and Order, the licensee's license has been revoked effective August 18, 2022. The licensee is excluded from facilities licensed by the Department for two years.
During today's case management visit, the LPA observed no children in care or any evidence of childcare being provided at this address. A tour of the home was provided to the LPA by the licensee. Confirmation of facility closure is complete.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Yang Yang
LICENSING EVALUATOR SIGNATURE: DATE: 09/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/09/2022
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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