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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173010434
Report Date: 02/28/2025
Date Signed: 02/28/2025 11:16:40 AM

Document Has Been Signed on 02/28/2025 11:16 AM - 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:STULTZ RACHAEL FCCHFACILITY NUMBER:
173010434
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
02/28/2025
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:31 AM
MET WITH:Rachael StultzTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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On 02/28/2025, Licensing Program Analyst, Sebastian Phouthavong has conducted Case Management Visit regarding Licensee making changes to the facility. Today, LPA met with Licensee, Rachael Stultz. Prior to visit, Licensee notified the department of the changes on 02/24/2025.

During the inspection the home was toured inside and outside. No children were receiving care during the time of visit. LPA observed an additional fence added to a section backyard to make that area inaccessible to dacyare children. LPA also observed the living room/Child Care room to not be operational but was inaccessible to daycare children by gate. In addition the living room/Child care room is currently off-limits.

The living room/Child Care room will be approved to be on-limits, once the Licensee submits an updated facility sketch and submit proof of the area being appropriate for daycare/children.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Licensee, Rachael Stultz

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

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE: DATE: 02/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/28/2025
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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