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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010371
Report Date: 08/30/2023
Date Signed: 08/30/2023 03:00:44 PM

Document Has Been Signed on 08/30/2023 03:00 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:JENSEN, AMBER FCCHFACILITY NUMBER:
493010371
ADMINISTRATOR:JENSEN, AMBERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 889-3462
CITY:PETALUMASTATE: CAZIP CODE:
94952
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
08/30/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Amber JensenTIME COMPLETED:
03:15 PM
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
Licensing Program Analyst (LPA) Glenn Ouye and Robert Maciel met with licensee Amber Jensen who has submitted a request to increase the capacity from a small to a large family child care home. The licensee has demonstrated sufficient experience to operate as a large family child care home. An exception has been approved by the department. The exception will be required to be posted until March 20, 2024.

LPA's discussed the child care ratio with the licensee and staff requirements.

The facility has been approved as a large family child care home effective August 25, 2023.

No deficiencies during the visit.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 08/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2023
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