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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483003697
Report Date: 05/14/2024
Date Signed: 05/14/2024 02:10:14 PM

Document Has Been Signed on 05/14/2024 02:10 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:BELLARD-HODGE, PRISCILLA FAMILY CHILD CARE HOMEFACILITY NUMBER:
483003697
ADMINISTRATOR/
DIRECTOR:		BELLARD-HODGE, PRISCILLAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 330-6565
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
05/14/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Licensee Priscilla Bellard- HodgeTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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Licensing Program Analyst ( LPA) Elpidia Hernandez Torres arrived to the Family Child Care Home ( FCCH) on 05/14/2024 to verify Adult (A1) is not working, residing, volunteering or in the presence at the day care.

Licensee reported A1 was a guardian of a previously enrolled child (C1). A1 attempted to volunteer at the day-care September of 2022. C1 was enrolled at the day care from August 2022- April 2023. A1 dis-enrolled C1 in April 2023. Licensee reported A1 never worked, or volunteered at the day care during child's time of enrollment.

LPA toured the home and did not find any sign of A1 residing in the home. LPA interviewed Staff (A2) of the day care. A2 reported they have not seen A1, and A1 does not work nor volunteer in the day care.

LPA reviewed decision and order effective 04/08/2024 which states A1 "... is prohibited from employment in, presence in, and contact with clients of an facility licensed by the department. . ."

This report was reviewed with licensee, a copy was provided. There were no deficiencies issued at time of inspection. Notice of Site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE: DATE: 05/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/14/2024
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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