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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 480111002
Report Date: 07/31/2023
Date Signed: 07/31/2023 01:30:09 PM


Document Has Been Signed on 07/31/2023 01:30 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:LAFORCARDE FAMILY DAY CAREFACILITY NUMBER:
480111002
ADMINISTRATOR:LAFORCARDE, ROXANNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 425-7219
CITY:SUISUNSTATE: CAZIP CODE:
94585
CAPACITY:14CENSUS: 0DATE:
07/31/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Roxann Laforcarde - LicenseeTIME COMPLETED:
01:40 PM
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Licensing Program Analyst (LPA), Melchisedeck Augustin made an unannounced Case Management visit to verify the facility's operational status. The Department made several prior attempted visits to the facility, however; there was no answer at the door. During the visit, LPA did not observe any child(ren) in care, and based on LPA's observations, the facility was unkempt. LPA met with Licensee; Roxann Laforcarde (LS) who confirmed the facility was currently closed due to personal reason(s). LS requested for the Department to place the facility license on inactive status starting 07/31/23 through 12/30/23, completed and submitted "LIC 9211", and Department records confirmed the facility fee are paid through 12/30/23. The facility license will be placed on inactive status for period specified above.

LS understood that the facility may be placed on inactive status for up to 12 months, and the inactive status may only be extended through the facility's anniversary date. LS also understood she may request the facility status be changed from inactive status to licensed status, however; the facility is subject to an inspection prior to being placed on licensed status.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:
DATE: 06/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2023
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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