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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010364
Report Date: 10/30/2023
Date Signed: 10/30/2023 04:15:58 PM

Document Has Been Signed on 10/30/2023 04:15 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 RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:LITTLE MONARCHS PRESCHOOLFACILITY NUMBER:
493010364
ADMINISTRATOR:IRIDIAN SANCHEZFACILITY TYPE:
850
ADDRESS:3267 AIRWAY DRIVETELEPHONE:
(707) 479-5577
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY: 57TOTAL ENROLLED CHILDREN: 67CENSUS: 20DATE:
10/30/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH: Licensee, Zoe TeeterTIME COMPLETED:
04:20 PM
NARRATIVE
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On 10/30/2023, Licensing Program Analysts (LPA), Sebastian Phouthaovong made an unannounced Case Management visit in response to a self reported, lack of supervision Unusual Incident Report (UIR) submitted on 10/18/2023. UIR was regarding child being unsupervised for approximately 3 minutes located in the outdoor play area. LPA met with Licensee, Zoe Teeter and spoke with her the regarding today's visit.

During today's inspection, LPA toured the facility inside and out and observed 20 children being supervised by 6 staff members. LPA conducted interviews with the Licensee, Site Supervisor and four staff members. Licensee stated a child was able go to the outdoor play area undetected. The child was immediately found and let inside, appearing upset. Licensee stated the child was checked on and authorized representatives of the child were immediately notified; being understanding of the incident. Licensee stated the incident was addressed with all staff and have updated the facility supervision procedure to enure no child is left unattended without a staff member. Staff interview corroborated Licensee's Statement.

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.

Exit interview conducted and report was reviewed with facility representative, Zoe Teeter.

The following violation of the California Code of Regulations, Title 22; Division 12, was observed: see LIC 809 D. Appeal rights were given.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE: DATE: 10/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/30/2023
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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Document Has Been Signed on 10/30/2023 04:15 PM - It Cannot Be Edited


Created By: Sebastian Phouthavong On 10/30/2023 at 03:37 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: LITTLE MONARCHS PRESCHOOL
FACILITY NUMBER: 493010364

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/30/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/13/2023
Section Cited
CCR
101229(a)(1)

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101229(a)(1) Responsibility for Providing Care and Supervision: (a) The licensee shall provide care and supervision....(1) No child(ren) shall be left without the supervision of a teacher at any time,...This requirement was not met as evidenced by
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Licensee stated she will submit a summary of the training along with proof of attendance to the LPA by 11/13/23.
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Based on the Licensee's admission of a unusual incident report (UIR) submitted 10/18/2023, a child was being unsupervised for approximately 3 minute located at the outdoor play area.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Leslie Lepori
LICENSING EVALUATOR NAME:Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE:
DATE: 10/30/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/30/2023


LIC809 (FAS) - (06/04)
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