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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483009327
Report Date: 04/26/2023
Date Signed: 04/26/2023 03:13:27 PM


Document Has Been Signed on 04/26/2023 03:13 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:SILVA, ERIKA FCCHFACILITY NUMBER:
483009327
ADMINISTRATOR:SILVA, ERIKAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 704-5683
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY:14CENSUS: 0DATE:
04/26/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Licensee is unavailableTIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA), Melchisedeck Augustin made an attempted unannounced Case Management visit for the purpose of addressing the facility’s outstanding fee balance of $210.50 that was due by 12/16/2022. The Department provided the facility with multiple reminders of the past due fee, including a letter notifying that the facility license was forfeited for non-payment of fee and prior attempted unannounced visit on 03/24/23, however; the Licensee, Erika Silva (LS) did not respond.

During today’s attempted visit, LS was not home, however; another adult (A1) that resided in the home answered the front door and notified that LS was no longer operating a childcare facility. LPA requested to take a tour of the home, however; A1 denied LPA entry into the home, and as such, LPA a tour of the home to was not conducted to verify operating status. LPA did not see or hear children, and as such, the facility license is forfeited for failure to pay annual fee.

The facility license is forfeited in accordance with Health and Safety Code 1596.803(e) which indicates that the failure of an applicant for licensure or a licensee to pay all applicable and accrued fee and civil penalties shall constitute grounds for denial or forfeiture of a license. The facility license will be closed effective, 04/26/2023.

This report as well as, license exemptions of California Code of Regulations (CCR) 102358 Which indicates a family day care home may provide care for the children of only one family in addition to the operator's own children, will be mailed to LS. Licensee was unavailable for signature.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:
DATE: 03/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/24/2023
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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