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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010486
Report Date: 08/25/2026
Date Signed: 08/25/2026 04:46:20 PM

Document Has Been Signed on 08/25/2026 04:46 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:LITTLE MONARCHSFACILITY NUMBER:
493010486
ADMINISTRATOR/
DIRECTOR:		DANA POWELLFACILITY TYPE:
860
ADDRESS:3273 AIRWAY DRIVE SUITE ETELEPHONE:
(707) 479-5577
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY: 170TOTAL ENROLLED CHILDREN: 170CENSUS: 61DATE:
08/25/2026
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:01 PM
MET WITH:Zoe TeeterTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
NARRATIVE
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On 08/25/2026, Licensing Program Analyst (LPA), Sebastian Phouthavong made an unannounced Case Management visit in response to a self-reported Unusual Incident Report (UIR) regarding a child being serviced milk when being alleged to milk. The UIR was received to Community Care Licensing on 08/17/2026. LPA met with Licensee, Zoe Teeter and spoke with her about the purpose of today's visit.

During today's inspection, LPA toured the facility inside and out and observed 61 children being supervised. LPA conducted interviews with Licensee, Assistant Director and one adult. Licensee, Assistant Director admitted that a staff member served milk to a child, not knowing the child had a milk allergy. Furthermore, Licensee, Assistant Director and one adult stated the child later needed medical treatment by medical professions due to an allergy reaction. In addition, Licensee, Assistant Director and one adult stated there was a previous incident regarding the child’s allergy. According to record review, it was indicates that the child has a milk allergy on file.

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

California Code of Regulations, Title 22, is being cited on the attached LIC 809-D. Appeal rights were provided. An exit interview was conducted, and this report was read and discussed with Licensee, Zoe Teeter. The Notice of Site Visit shall be posted for 30 days.

Reports citing Type A violation are to be provided to parents/guardians of children currently enrolled by the next business day or the next day the children are in care, and to parents/guardians of children newly enrolled at the facility for the next 12 months from the date of this report. Parents/guardians must sign Form LIC 9224 to be kept in each child's file.

Melinda Mohr
Sebastian Phouthavong
DATE: 08/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/25/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 08/25/2026 04:46 PM - It Cannot Be Edited


Created By: Sebastian Phouthavong On 08/25/2026 at 04:17 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
FACILITY NUMBER: 493010486

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/25/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/26/2026
Section Cited
CCR
101227(7)(B)

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101227(7)(B) Food Services: A child shall not be served any food to which the child's record indicates he/she has an allergy. This requirement is not met as evidenced by:
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Licensee stated that she will submit a updated facility policy regarding allergies to LPA by email: sebastian.phouthavong@dss.ca.gov by 08/26/2026.
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Based on record reviews and interviews, a child was served milk by a staff member, however the child has a milk allergy and needed medical treatment, which poses an immediate health and safety risk to children in care.
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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.
Melinda Mohr
NAME OF LICENSING PROGRAM MANAGER:
Sebastian Phouthavong
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/25/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/25/2026


LIC809 (FAS) - (06/04)
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