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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010046
Report Date: 01/30/2023
Date Signed: 01/30/2023 03:47:14 PM

Document Has Been Signed on 01/30/2023 03:47 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:SMILEY, CHRISTA FCCHFACILITY NUMBER:
493010046
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
01/30/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Christa SmileyTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Glenn Ouye met with licensee, Christa Smiley to conduct a capacity increase case management visit. The application was received on December 29, 2022.

The fire inspection was conducted today (1/20/2023). LPA is awaiting the approved fire clearance from Sonoma County Fire District's inspector Ryan Osborne.

The facility has functioning smoke and carbon monoxide detectors. There is a charged fire extinguisher and a pull station. The home is also equipped with fire sprinklers throughout the home.

When the approved fire clearance is received the home will be approved as a large FCCH.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 01/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2023
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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