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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 283008142
Report Date: 08/06/2024
Date Signed: 08/06/2024 01:49:14 PM


Document Has Been Signed on 08/06/2024 01:49 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 - PHILLIPS CHARTER STATE PRESCHOOLFACILITY NUMBER:
283008142
ADMINISTRATOR:ROSALES, PAULAFACILITY TYPE:
850
ADDRESS:1210 SHETLER AVENUETELEPHONE:
(707) 253-3481
CITY:NAPASTATE: CAZIP CODE:
94559
CAPACITY:31CENSUS: 0DATE:
08/06/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:34 PM
MET WITH:TIME COMPLETED:
01:50 PM
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On 08/06/2024 Licensing Program Analyst (LPA) Mindy Mohr made an unannounced inspection at the facility to verify closure of the preschool program. On 07/22/2024 SRRO received a copy of the facilities license with the following statement written on the back:

Effective June 30, 2024 we are closing the classroom NCOE Phillips Charter State Preschool located on the Phillips Elementary School Campus.

During today's inspection, LPA did not observe any children in care. There was no evidence to indicate that the preschool is still operating. The facility license will be closed by the RO effective 08/06/2024.

Because the facility is no longer in operation, a facility representative was not available for signature.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melinda MohrTELEPHONE: (707) 494-2125
LICENSING EVALUATOR SIGNATURE:
DATE: 08/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/06/2024
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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