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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173010786
Report Date: 01/08/2025
Date Signed: 01/08/2025 11:44:51 AM

Document Has Been Signed on 01/08/2025 11:44 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:MCBRAYER, MICHELLE FCCHFACILITY NUMBER:
173010786
ADMINISTRATOR/
DIRECTOR:		MICHELLE MCBRAYERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 350-5345
CITY:CLEARLAKESTATE: CAZIP CODE:
95422
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
01/08/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:20 AM
MET WITH:Michelle McBrayerTIME VISIT/
INSPECTION COMPLETED:
11:50 AM
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On 01/08/2025, at 11:20AM, Licensing Program Analyst, Sebastian Phouthavong made an announced Case Management visit to the facility and met with Licensee, Michelle McBrayer regarding the facility's Payment Pan Agreement due to a civil penalty assessment issued on 09/20/2024 under the previous license number: 173008720.

During the visit, LPA observed two children being supervised by Licensee. Licensee reviewed Payment Plan for the civil penalty and have agreed to the terms. Licensee reviewed If no payment received by due date, conduct case management and issue citation: 1596.803(e) The failure of an applicant for licensure or a licensee to pay all applicable and accrued fees and civil penalties shall constitute grounds for denial or forfeiture of a license. LPA received documentation of the Payment Plan and will provided copy to Licensee.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee, Micelle McBrayer

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE: DATE: 01/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/08/2025
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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