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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 280105673
Report Date: 12/12/2023
Date Signed: 12/12/2023 03:29:51 PM


Document Has Been Signed on 12/12/2023 03:29 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:NCOE - ST. HELENA CHILD DEVELOPMENT CENTERFACILITY NUMBER:
280105673
ADMINISTRATOR:MARIANNE STEGMANFACILITY TYPE:
850
ADDRESS:1428 SPRING STREETTELEPHONE:
(707) 963-7204
CITY:ST. HELENASTATE: CAZIP CODE:
94574
CAPACITY:25CENSUS: 0DATE:
12/12/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:13 PM
MET WITH:TIME COMPLETED:
03:30 PM
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On 12/12/2023 a case management visit was made to the facility by Licensing Program Analyst (LPA) M. Mohr to conduct a confirmation of facility closure visit.

During today's case management visit, the LPA observed no children in care or any evidence of childcare being provided at this address. There was no one present during this visit. There did not appear to be any evidence of childcare being provided at this address.

Confirmation of facility closure is complete.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melinda MohrTELEPHONE: (707) 494-2125
LICENSING EVALUATOR SIGNATURE:
DATE: 12/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/12/2023
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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