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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483008407
Report Date: 02/14/2024
Date Signed: 02/14/2024 09:31:40 AM


Document Has Been Signed on 02/14/2024 09:31 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:HIXSON, JENNIFER FAMILY CHILD CARE HOMEFACILITY NUMBER:
483008407
ADMINISTRATOR:HIXSON, JENNIFERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 689-8952
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY:14CENSUS: 0DATE:
02/14/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jennifer Hixson - LicenseeTIME COMPLETED:
09:45 AM
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During the course of a complaint investigation, Licensing Program Analyst (LPA), Melchisedeck Augustin made an unannounced Case Management (CM) visit and met with Licensee (LS), Jennifer Hixson to verify the facility’s operational status. On 02/08/24, LPA interviewed two staff (S2 & S3) who stated LS sold the home approximately two weeks ago, the facility was not in operation; and the facility was permanently closed.

During the visit, LS confirmed she sold the home and donated all the daycare equipment, and the facility closed effective, 01/15/24. LS allowed LPA to take a tour of the home and some of the furnishing in the home had been removed. LPA did not see or hear any daycare children in the home and LPA did not see evidence or indication to suggest that childcare services was being provided. LS submitted her original license and a written statement reflecting she was no longer interested in operating a childcare facility.

The facility license is forfeited in accordance with California of Code of Regulations (CCR) 102383(a)(1), and the facility license will be closed effective, 02/14/2024. LPA provided LS with copies of California Code of Regulations (CCR) 102383 and 102358 which respectively provides information on license exemptions and indicated that the provider may provide care for her own children and for the children of one family. This report was discussed and reviewed with LS.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:
DATE: 02/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/14/2024
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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