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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 490111872
Report Date: 07/11/2024
Date Signed: 07/11/2024 02:30:04 PM

Document Has Been Signed on 07/11/2024 02:30 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:WOOD-SHAW, JANET FCCHFACILITY NUMBER:
490111872
ADMINISTRATOR/
DIRECTOR:		WOOD-SHAW, JANET FCCHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 795-8568
CITY:SEBASTOPOLSTATE: CAZIP CODE:
95472
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
07/11/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:45 PM
MET WITH:no one homeTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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LPA Ouye arrived to conduct a confirmation of closure visit. LPA knocked on daycare door and range front door bell. No answer. The phone is also disconnected. There does not appear to be any daycare operations.

The licensee did submit a letter announcing her retirement at of June 7 2024.

LPA will proceed with the closure of the facility effective June 7, 2024.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/11/2024
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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