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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493008907
Report Date: 11/25/2024
Date Signed: 11/25/2024 01:49:20 PM

Document Has Been Signed on 11/25/2024 01:49 PM - 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:NOVOA, LORENA FCCHFACILITY NUMBER:
493008907
ADMINISTRATOR/
DIRECTOR:		NOVOA, LORENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 322-1425
CITY:SANTA ROSASTATE: CAZIP CODE:
95407
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
11/25/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:10 PM
MET WITH:Margarita ChavezTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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A case management visit to the facility was made today by Licensing Program Analyst (LPA) Amy Strother at the request of the licensee, Lorena Novoa to inspect and approve a previously “off limits” area of the home for child care use. The licensee is requesting approval to utilize one bedroom in the home that was previously off-limits. During today's visit, LPA met with assistant Margarita Chavez (S1). S1 stated that Licensee, Lorena Novoa is not home and will not be home today. S1 allowed LPA into the home to inspect the bedroom. LPA obtained a copy of an updated facility sketch that reflects the bedroom as “on limits” during the visit. The room will be labeled as "4 bedroom open" on the floor sketch created by the licensee. LPA inspected and toured the bedroom. The bedroom was free of hazards and can now be used as an on-limits for child care use. The bedroom is on limits effective today, 11/25/24. There are no other changes to the facility's interior floor plan.

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

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

This report was translated to Spanish using Google translate for review with assistant, Margarita Chavez.

SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE: DATE: 11/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/25/2024
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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