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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483006806
Report Date: 12/21/2023
Date Signed: 02/16/2024 09:21:55 AM

Document Has Been Signed on 02/16/2024 09:21 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:MOREHEAD, LORI FAMILY CHILD CARE HOMEFACILITY NUMBER:
483006806
ADMINISTRATOR:MOREHEAD, LORIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 864-1219
CITY:FAIRFIELDSTATE: CAZIP CODE:
94534
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
12/21/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Lori MoreheadTIME COMPLETED:
09:30 AM
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On 02/16/2024, Licensing Program Analyst, Selena Mariani made an unannounced Case Management visit to the facility and met with Licensee (L1), Lori Morehead to verify the facility operation status.

During the visit, LPA Selena did not observe children in care. L1 completed and submitted an LIC9211 Request For Inactive Child Care License Status effective dates 02/16/2024 through 08/30/2024.

Exit interview conducted and report was reviewed with the Licensee, Lori Morehead.

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Selena Mariani
LICENSING EVALUATOR SIGNATURE: DATE: 12/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/21/2023
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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