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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
475407728
Report Date:
08/03/2022
Date Signed:
08/03/2022 11:17:52 AM
Document Has Been Signed on
08/03/2022 11:17 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
,
520 COHASSET RD., SUITE 170
CHICO
,
CA
95926
FACILITY NAME:
LAWRENCE-SAMPSON FAMILY CHILD CARE HOME
FACILITY NUMBER:
475407728
ADMINISTRATOR:
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
CITY:
STATE:
ZIP CODE:
CAPACITY:
8
TOTAL ENROLLED CHILDREN:
8
CENSUS:
DATE:
08/03/2022
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
10:45 AM
MET WITH:
Breezy McFall
TIME COMPLETED:
11:20 AM
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On 08/03/22 Licensing Program Analyst (LPA) N. Cunningham conducted a visit to conduct an annual inspection. The licensee was unavailable. A household member reported that no daycare children are in care. LPA observed a quiet home. LPA did not observe daycare children at the FCCH. LPA will conduct another visit in order to complete the annual required inspection.
SUPERVISORS NAME
:
Erin Virrueta
LICENSING EVALUATOR NAME
:
Nicolette Cunningham
LICENSING EVALUATOR SIGNATURE
:
DATE:
08/03/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/03/2022
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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