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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483009622
Report Date: 10/12/2022
Date Signed: 10/12/2022 09:18:51 AM


Document Has Been Signed on 10/12/2022 09:18 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:BELL, MIESHA FCCHFACILITY NUMBER:
483009622
ADMINISTRATOR:BELL, MIESHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 712-5973
CITY:VALLEJOSTATE: CAZIP CODE:
94590
CAPACITY:14CENSUS: 0DATE:
10/12/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Licensee is unavailableTIME COMPLETED:
09:30 AM
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Licensing Program Analyst (LPA), Melchisedeck Augustin made an announced Case Management visit to verify operation status of the facility. On 10/12/22, the Licensee, Miesha Bell (LS) forfeited the original facility license with written statement reflecting her request to close the facility effective, 10/10/22. During today's visit, LS was unavailable, however; the contractor working in the vacant home provided LPA with the opportunity to tour the interior of the home.

There were no furnishing or items inside the home and there was no indication that a childcare facility was being operated in the home, and 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, 10/10/2022. 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: 10/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/12/2022
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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