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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173010033
Report Date: 08/25/2021
Date Signed: 08/26/2021 11:01:24 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:BOHAN, NAHANI FCCHFACILITY NUMBER:
173010033
ADMINISTRATOR:BOHAN,NAHANIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 287-0551
CITY:KELSEYVILLESTATE: CAZIP CODE:
95451
CAPACITY:14CENSUS: 0DATE:
08/25/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Nahani Bohan, LicenseeTIME COMPLETED:
09:00 AM
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On 8/25/2021 at 8:15am, Licensing Program Analyst (LPA) N. Cunningham conducted a case management inspection a body of water. The Licensee stated that she has not provided care for children since she obtained her FCCH license. The licensee also stated that she is waiting to enroll children until she finishes a construction project which affects the fencing. During todays inspection, the licensee completed a request for inactive status.

This report was reviewed and discussed with the licensee. All licensing reports are public information and must be made available upon request for at least three years.
Notice of Site Visit shall be posted for 30 days from today's visit.

There were no Title 22 deficiencies cited during today's inspection.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Nicolette CunninghamTELEPHONE: (707) 588-5056
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021
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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