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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483010241
Report Date: 01/30/2025
Date Signed: 01/30/2025 10:26:20 AM

Document Has Been Signed on 01/30/2025 10:26 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 CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:SEDIQI, MONISA FCCHFACILITY NUMBER:
483010241
ADMINISTRATOR/
DIRECTOR:		MONISA SEDIQIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 999-6699
CITY:FAIRFIELDSTATE: CAZIP CODE:
94534
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
01/30/2025
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:35 AM
MET WITH:Monisa SediqiTIME VISIT/
INSPECTION COMPLETED:
10:45 AM
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On 01/30/2025 at 8:35 am, Licensing Program Analyst, Selena Mariani made an announced Case Management Licensee Initiated visit to the facility and met with Licensee (LS), Monisa Sediqi and Staff 1 (S1) Roheena Sediqi today to inspect garage for use at the facility.

During the visit, LPA observed 3 staff supervising 8 day care children in care and toured the on-limits area of the home. The on-limit areas of the home are kitchen, living room, bathroom near living room. The home outdoor on-limit areas are gazebo and left side yard. Off-limit areas are made inaccessible by door lock, child gate or door knob cover.

In addition, to the inspection, LPA reviewed the added change to the facility. The facility's garage was converted to a living space area. The change has been approved and Licensee submitted an updated facility sketch to the department.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee, Monisa Sediqi.

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

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Selena Mariani
LICENSING EVALUATOR SIGNATURE: DATE: 01/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2025
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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