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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493009801
Report Date: 08/14/2024
Date Signed: 08/14/2024 09:00:28 AM

Document Has Been Signed on 08/14/2024 09:00 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:MOONEY, ANN FCCHFACILITY NUMBER:
493009801
ADMINISTRATOR/
DIRECTOR:		ANN MOONEYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 335-5259
CITY:PETALUMASTATE: CAZIP CODE:
94952
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/14/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:43 AM
MET WITH:Ann MooneyTIME VISIT/
INSPECTION COMPLETED:
09:12 AM
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An unannounced case management visit was made to the facility by Licensing Program Analyst (LPA) Robert Maciel to conduct a confirmation of closure. On 06/20/2024 Licensee emailed LPA that she would closing the facility and the last day would be on 7/31/2024. During today's case management visit, the LPA observed no daycare children in care. The LPA provided the licensee with a confirmation of facility closure receipt letter during this visit.

Confirmation of facility closure is complete. Facility will be closed as of today 08/14/2024.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Robert Maciel
LICENSING EVALUATOR SIGNATURE: DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/14/2024
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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