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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 480112064
Report Date: 03/06/2020
Date Signed: 03/06/2020 03:17:55 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME:ARMSTRONG, LORRAINE FAMILY CHILD CARE HOMEFACILITY NUMBER:
480112064
ADMINISTRATOR:ARMSTRONG, LORRAINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 643-3180
CITY:VALLEJOSTATE: CAZIP CODE:
94589
CAPACITY:14CENSUS: 11DATE:
03/06/2020
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Lorraine ArmstrongTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Melchisedeck Augustin made an unannounced Case Management inspection, in response to the Licensee's outstanding Annual fee of $210. The Licensee's Annual fee was due on 02/10/20. LPA met with Licensee Lorraine Armstrong and LPA discussed with the purpose of the inspection with the Licensee. During today's inspection, LPA informed the Licensee of her outstanding fee. The Licensee stated that she thought she had paid her annual fee, and the Licensee requested from the Department, the opportunity to pay her fees online in full. LPA issued an Advisory Note for this Technical Violation. The Licensee was provided with the opportunity to pay her Annual fee of $210 in full on the CCLD transparency website at www.ccld.ca.gov; and the Licensee provided a confirmation of payment receipt to LPA. LPA provided the online payment PIN to the Licensee. LPA discussed with the Licensee, and the Licensee is aware and acknowledges that failure of an applicant for licensure or Licensee to pay all applicable and accrued fees and Civil Penalty shall constitute grounds for denial or forfeiture of a license.

This report was reviewed and discussed with the Licensee. Notice of Site Visit shall be posted for 30 days from today's inspection. There were no Title 22 deficiency cited during today's inspection.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020
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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