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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483009521
Report Date: 12/16/2022
Date Signed: 12/16/2022 01:55:45 PM


Document Has Been Signed on 12/16/2022 01:55 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:DILLON, LATONYA FCCHFACILITY NUMBER:
483009521
ADMINISTRATOR:DILLON, LATONYAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(817) 870-6319
CITY:VALLEJOSTATE: CAZIP CODE:
94590
CAPACITY:14CENSUS: 0DATE:
12/16/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Licensee is unavailableTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA), Melchisedeck Augustin made an unannounced Case Management visit to verify operation status of the facility. On 09/07/22, the Licensee, Latonya Dillon (LS) notified the Department of her intent to vacate the facility and relocated out of the county. During today's visit, LS was unavailable and LPA did not have access into the home, however; certain interior areas of the home were visible through the clear windows at the front of the home, and based on LPA’s observations, there were no furnishing, daycare equipment or items inside the home, and there was no indication that a childcare facility was being operated in the home; as well as LPA did not see any daycare children in the home.

The facility license is forfeited in accordance with California Code of Regulations (CCR) 102383(a)(1), and the license will be closed effective, 12/16/2022. LS was unavailable to review this report, however; a copy of this report and CCR 102358 will be mailed to LS.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:
DATE: 12/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/16/2022
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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