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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 490109143
Report Date: 07/03/2024
Date Signed: 07/03/2024 03:18:35 PM


Document Has Been Signed on 07/03/2024 03:18 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 CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:LA PETITE ACADEMY - SCHOOL AGE/SANTA ROSAFACILITY NUMBER:
490109143
ADMINISTRATOR:SARAH MORRISONFACILITY TYPE:
840
ADDRESS:2055 OCCIDENTAL ROADTELEPHONE:
(707) 573-1623
CITY:SANTA ROSASTATE: CAZIP CODE:
95401
CAPACITY:28CENSUS: 0DATE:
07/03/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Sarah MorrisonTIME COMPLETED:
03:30 PM
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On 07/03/24 Licensing Program Analyst (LPA) Strother arrived to the facility to conduct an Annual/Random Inspection for the School-Age license and met with Director, Sarah Morrison (D1). D1 stated that the School-Age license is not currently in use, with no plans of reopening the room for care. LPA requested that the Licensee either submit a request to place the license on inactive status or close the license if not planning to use it in the future. D1 connected LPA Strother with District Manager, Rosy Tichauer (D2) who acts as the facilities Licensee/Applicant. D2 emailed a letter, attention LPA Strother during the visit, stating that as of 07/03/24 she would like to terminate the school-age license. During today's visit, LPA Strother confirmed closure, confirming that the school-age room was not occupied and no school-age children were present. D1 provided LPA with the physical license, signing and dating the back of the license with a statement regarding date of closure, 07/03/24.

A copy of this report, was provided to facility representative, Sarah Morrison. A closure letter will be mailed to the mailing address on file. Effective, 07/03/24 facility #490109143 is no longer licensed and can no longer provide licensed care to children.

LPA Strother will process the closure with the effective closure date of 07/03/24.

SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy StrotherTELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:
DATE: 07/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/03/2024
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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