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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313616805
Report Date: 08/01/2024
Date Signed: 08/01/2024 01:03:36 PM

Document Has Been Signed on 08/01/2024 01:03 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:CASILLAS, CHARLOTTEFACILITY NUMBER:
313616805
ADMINISTRATOR/
DIRECTOR:		CASILLAS, CHARLOTTEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 409-5575
CITY:LINCOLNSTATE: CAZIP CODE:
95648
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
08/01/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:20 PM
MET WITH:Charlotte CasillasTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On Thursday, August 1, 2024, Licensing Program Analyst (LPA) Lea Habtom arrived at the family child care home. LPA explained to licensee the purpose of the inspection in which licensee stated she closed the child care last year and got a job outside of the child care. LPA explained to licensee that no contact was received to close the child care. Licensee provided a written statement to LPA requesting to close family child care home effective August 1, 2024.The conversation was conducted at the door outside of the home.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE: DATE: 08/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/01/2024
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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