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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045406849
Report Date: 07/30/2019
Date Signed: 07/30/2019 11:45:12 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:KUMAR, MICHELE FAMILY CHILD CARE HOMEFACILITY NUMBER:
045406849
ADMINISTRATOR:KUMAR, MICHELEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 990-8135
CITY:PALERMOSTATE: CAZIP CODE:
95968
CAPACITY:14CENSUS: 13DATE:
07/30/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Michele KumarTIME COMPLETED:
11:55 AM
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A Confirmation of Removal letter (COR) dated 07/16/2019 was received by this Department.

On 07/21/19 Licensing Program Analyst (LPA) David Wilson received an email from licensee Michele Kumar that stated licensee has received COR and that the individual listed on COR has not worked or been at facility since "October 2018".

On 07/30/19 LPA Wilson conducted a Confirmation of Removal Case Management unannounced inspection to the facility. Licensee stated confirming the individual listed on the COR has not worked or been at facility since "October 2018". LPA identified the two adults including licensee and assistant at the facility and observed that the individual listed on COR was not present at the time of the inspection.

Based on evidence obtained and today's inspection, this LPA has verified the individual is not present, employed or residing at the facility.

LPA found no evidence of this individual's presence at this facility, therefore LPA has determined the individual has been removed. Verification of removal is complete.
SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: David WilsonTELEPHONE: (530) 513-0993
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2019
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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