<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483008293
Report Date: 09/15/2021
Date Signed: 09/15/2021 09:54:35 AM

Document Has Been Signed on 09/15/2021 09:54 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,
, CA
FACILITY NAME:NEWSOME, SHARON FCCHFACILITY NUMBER:
483008293
ADMINISTRATOR:NEWSOME, SHARONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 648-0204
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
09/15/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:TIME COMPLETED:
10:05 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
LPA Kevin O'Connell made a case management inspection for the purpose of verifying that the Licensee had moved from the premises.
LPA rang the doorbell multiple times with no response. The black storm door was locked so I could not knock on the door.
The property was very tidy and no cars were parked in front or in the driveway. LPA approached the neighbor at 165 Drake Court who stated that his name was L. Lagman. He stated that he knew the Newsomes. I asked if he had observed them at the property and he stated that they had moved out. They started the move at the beginning of the month and finished the move last weekend. That was the last time that he had seen them.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Kevin O'Connell
LICENSING EVALUATOR SIGNATURE: DATE: 09/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1