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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493008329
Report Date: 10/01/2024
Date Signed: 10/01/2024 10:41:40 AM

Document Has Been Signed on 10/01/2024 10:41 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:HARTLEY, LISA FCCHFACILITY NUMBER:
493008329
ADMINISTRATOR/
DIRECTOR:		HARTLEY, LISAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 539-5028
CITY:SANTA ROSASTATE: CAZIP CODE:
95409
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
10/01/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:44 AM
MET WITH:Lisa HartleyTIME VISIT/
INSPECTION COMPLETED:
10:51 AM
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Licensing Program Analyst (LPA), Robert Maciel made a Plan of Correction (POC) visit and met Licensee, Lisa Hartley (LS) for the purpose of following up on outstanding plans of correction that were due by 8/14/24 and 8/16/24. The facility was previously cited on 8/2/24 for staff not possessing current Mandated Reporter training certificates and on 8/7/24 for not obtaining signed LIC9224 Acknowledgement of Receipt of Licensing Reports for all enrolled children.

During today's visit, LS showed LPA current Mandated Reporter Training certificates for all current staff and the LIC9224 Acknowledgement of Receipt of Licensing Reports for all currently enrolled children. Both outstanding plans of correction have been met and LPA provided the Licensee with Letters of Deficiency Citations Cleared for each deficiency.

Exit interview conducted and report was reviewed with the Licensee, Lisa Hartley. 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. No deficiencies were cited during today's inspection.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Robert Maciel
LICENSING EVALUATOR SIGNATURE: DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/01/2024
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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