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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 233009332
Report Date: 01/12/2023
Date Signed: 01/12/2023 11:50:07 AM


Document Has Been Signed on 01/12/2023 11:50 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:HENDRICKS, KRISTINE FCCHFACILITY NUMBER:
233009332
ADMINISTRATOR:HENDRICKS, KRISTINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 962-3003
CITY:FORT BRAGGSTATE: CAZIP CODE:
95437
CAPACITY:14CENSUS: 5DATE:
01/12/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Kristine HendricksTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Glenn Ouye met with licensee Kristine Hendricks who asked to have her home measured to determine the capacity if she changes the home to a child care center.

LPA Ouye measured the interior and exterior of home and consulted with the licensee regarding the potential changes. LPA Ouye has already evaluated the licensee qualification as a director. She has the necessary work experience and college classes to operate as the director of a infant, preschool or school age center.

LPA provided the licensee with measurements of the rooms and outdoor activity area.



No citations issued during the inspection.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Glenn OuyeTELEPHONE: (707) 588-5042
LICENSING EVALUATOR SIGNATURE:
DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/12/2023
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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