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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173003428
Report Date: 10/26/2023
Date Signed: 10/26/2023 01:42:04 PM


Document Has Been Signed on 10/26/2023 01:42 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:HAMNER, LINDA FAMILY CHILD CARE HOMEFACILITY NUMBER:
173003428
ADMINISTRATOR:HAMNER, LINDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 279-0702
CITY:KELSEYVILLESTATE: CAZIP CODE:
95451
CAPACITY:14CENSUS: 0DATE:
10/26/2023
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Linda HamnerTIME COMPLETED:
01:55 PM
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On 10/26/2023, at 12:50PM, Licensing Program Analyst, Sebastian Phouthavong made an announced Case Management visit to the facility and met with Licensee, Linda Hamner to verify operation at the facility, and to address the facility's forfeiture. Prior to visit, 10/20/2023, LPA has Certification of Non-Operation and confirmed the facility's closure.

During the today visit, LPA toured the home inside and out. There was no evidence of operation and/or childcare being provided at the facility. Licensee stated she has not been operating since 06/30/2023. Licensee stated she is currently changed her mind on forfeiting her Licensee and requested time to decide if she wants to close her Family Child Care Home.

Licensee reviewed the requirements for License Exemption and the regulation was provided. LPA informed Licensee that a new application must be submitted to Community Care Licensing to become license once again.

The Completion of Closure will be met once Licensee has decided to forfeit her license.

Exit interview conducted and report was reviewed with the Licensee, Linda Hamner.

SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Sebastian PhouthavongTELEPHONE: 707-588-5056
LICENSING EVALUATOR SIGNATURE:
DATE: 10/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/26/2023
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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