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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 490101798
Report Date: 07/02/2024
Date Signed: 07/02/2024 09:30:04 AM

Document Has Been Signed on 07/02/2024 09:30 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:SPRING HILL MONTESSORIFACILITY NUMBER:
490101798
ADMINISTRATOR/
DIRECTOR:		TANTI, AMYFACILITY TYPE:
850
ADDRESS:825 MIDDLEFIELD DRTELEPHONE:
(707) 763-9222
CITY:PETALUMASTATE: CAZIP CODE:
94952
CAPACITY: 107TOTAL ENROLLED CHILDREN: 107CENSUS: 45DATE:
07/02/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:TIME VISIT/
INSPECTION COMPLETED:
09:39 AM
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On 7/2/24, Licensing Program Analyst (LPA) Robert Maciel conducted a Case Management visit and spoke with facility representative Sandy Stack (FR) to discuss the qualifications of facility staff. FR stated that since LPA's last annual inspection on 3/27/24, only one new staff has been hired, staff 1 (S1). FR stated that S1 has been hired for the next school year and will start in August.
At 9:15 AM, LPA reviewed the staff record for S1 which revealed that S1 possesses appropriate qualifications for her position.
Report was reviewed with facility representative, Sandy Stack. A notice of site visit was given and must remain posted for 30 days. Failure to do so will result in an immediate civil penalty of 100 dollars. No deficiencies were cited during today's inspection.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Robert Maciel
LICENSING EVALUATOR SIGNATURE: DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/02/2024
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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