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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493005926
Report Date: 08/30/2023
Date Signed: 08/30/2023 12:31:23 PM

Document Has Been Signed on 08/30/2023 12:31 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:REYNOZA FAMILY CHILD CARE HOMEFACILITY NUMBER:
493005926
ADMINISTRATOR:REYNOZA, CYNDI & EMMAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 838-4062
CITY:WINDSORSTATE: CAZIP CODE:
95492
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/30/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:18 PM
MET WITH:N/ATIME COMPLETED:
12:39 PM
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A case management visit was made to the facility today by Licensing Program Analyst (LPA) Y.Yang to conduct a confirmation of facility closure visit. The facility's licensee, Cyndi Reynoza notified the LPA in writing that as of 08/28/23, she has relinquished her FCCH license and will no longer be providing childcare services at this address.

During today's case management visit, the LPA observed no children in care or any evidence of childcare being provided at this address. The licensee was not present during this visit. There did not appear to be any evidence of childcare being provided at this address.

Confirmation of facility closure is complete.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Yang Yang
LICENSING EVALUATOR SIGNATURE: DATE: 08/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2023
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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