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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173007616
Report Date: 06/03/2019
Date Signed: 06/03/2019 08:40:39 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:LEARNING HOUSE - P/S, THEFACILITY NUMBER:
173007616
ADMINISTRATOR:ANNA ROSE MONTANEZFACILITY TYPE:
850
ADDRESS:14840 BURNS VALLEY ROADTELEPHONE:
(707) 995-2076
CITY:CLEARLAKESTATE: CAZIP CODE:
95422
CAPACITY:65CENSUS: 14DATE:
06/03/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
07:50 AM
MET WITH:Medina DecostaTIME COMPLETED:
08:55 AM
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Licensing Program Analyst (LPA) Chris Arnhold arrived to this facility unannounced to conduct a case management visit in regards to an unusual incident report submitted on 05/20/2019. LPA met with S1 and S2 to discuss what actions this center has implemented to address inappropriate behaviors displayed by children. S1 stated that teachers are constantly observing children and redirecting as needed. Teachers will continue to report unusual behavior and work with families to ensure the needs of the children are met.
Notice of Site Visit shall be posted for 30 days from today's visit.

There were no Title 22 deficiencies cited during today's inspection.

SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Christopher ArnholdTELEPHONE: (707) 588-5056
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2019
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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