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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 480109783
Report Date: 05/03/2023
Date Signed: 05/03/2023 03:20:54 PM


Document Has Been Signed on 05/03/2023 03:20 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:LEONCIO FAMILY CHILD CARE HOMEFACILITY NUMBER:
480109783
ADMINISTRATOR:LEONCIO, GEORGIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 554-0264
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY:12CENSUS: 0DATE:
05/03/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Georgia Leoncio - LicenseeTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA), Melchisedeck Augustin made an unannounced Case Management visit to address the facility's outstanding annual fee of $210.00 that was due by 03/05/23 and the facility's inactive status which also expired on 03/05/23. The Department mailed multiple letters to the facility’s mailing address to remind the Licensee (LS) of the facility's outstanding fee, however; LS did not respond.

During today's visit, there were zero children present and there was no indication that LS was operating. LS elected to pay her outstanding balance and provided LPA with a payment confirmation receipt. Furthermore, LS expressed her interest in extending the facility's inactive status, and as such, LS completed a Request for Inactive Child Care License Status (LIC 9211) and provided LPA with a copy. LS understood she was required to pay the facility's annual fee and inactive status may only be extended through the facility's anniversary date. LS understood that the failure of an applicant or Licensee to pay all applicable and accrued fees and civil penalties pursuant to Health and Safety Code Sections 1523.1 or 1596.803, shall constitute grounds for denial or forfeiture of a license.

Furthermore, LS understood to change the facility status from "Inactive" to "Licensed", the facility is subject to an inspection to ensure compliance with Title 22, prior to being placed on licensed. The facility's inactive status will be extend starting 03/06/23 through 03/05/24. LPA discussed exempt care with LS and LS understood that she may only provide exempt care which includes providing care for LS's own children, plus one other family.

This report was discussed and reviewed the LS. There were no violation(s) of California Code of Regulations (CCR), Title 22, Division 12, Chapter 1, cited during today's visit.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:
DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2023
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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