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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493008329
Report Date: 10/23/2024
Date Signed: 10/23/2024 09:41:39 AM

Document Has Been Signed on 10/23/2024 09:41 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:
10/23/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:13 AM
MET WITH:Lisa HartleyTIME VISIT/
INSPECTION COMPLETED:
09:48 AM
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Licensing Program Analyst (LPA) Robert Maciel made a Licensee Initiated Case Management visit for the purpose of reviewing rooms the Licensee wants to add to the on-limits areas of the facility and met with Licensee Lisa Hartley.

On 10/18/24, Licensee emailed LPA an updated LIC999 Facility Sketch and stated that she wanted to add Bedroom 2 and the Master Bedroom to the facilty's on limits area. At 9:13 AM, LPA arrived at the facility and observed the Licensee supervising 6 children. LPA walked through the Master Bedroom and Bedroom 2. Licensee stated that both rooms will be used for napping infants. LPA reviewed the infant safe sleep regulations with the Licensee. Licensee stated the master bathroom in the master bedroom will not be used for childcare and will be made inaccessible by a door latch. Both rooms are cleared to use for childcare as of 10/23/24.

No deficiencies were cited during today's inspection. A notice of site visit was given and must remain posted for 30 days. Failure to do so shall result in an immediate civil penalty of $100
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Robert Maciel
LICENSING EVALUATOR SIGNATURE: DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2024
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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