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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 310321070
Report Date: 07/07/2022
Date Signed: 07/07/2022 02:15:47 PM

Document Has Been Signed on 07/07/2022 02:15 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:WITZ, JEANNETTE & PATRICKFACILITY NUMBER:
310321070
ADMINISTRATOR:WITZ, JEANNETTEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 386-8436
CITY:MEADOW VISTASTATE: CAZIP CODE:
95722
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
07/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Witz, Patrick JeanetteTIME COMPLETED:
02:30 PM
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LPA arrived for an unannounced required annual inspection. LPA met with licensee's Patrick and Jeanette who stated they would like retire and close out their license. The couple stated they only watch their grandchildren at this time. Four grandchildren were present at the time of inspection.

Effective today the license will be closed.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Amanda Blesi
LICENSING EVALUATOR SIGNATURE: DATE: 07/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/07/2022
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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