<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010486
Report Date: 03/05/2024
Date Signed: 03/05/2024 04:08:11 PM

Document Has Been Signed on 03/05/2024 04:08 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:MARTINEZ, IRIDIANFACILITY TYPE:
850
ADDRESS:3273 AIRWAY DRIVE SUITE ETELEPHONE:
(707) 479-5577
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
03/05/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Zoe TeeterTIME COMPLETED:
04:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
A change of ownership prelicensing inspection was conducted March 5, 2024 at noon-thirty by Licensing Program Analyst (LPA), J. Snow and Sebastian Phouthavong. LPAs Snow met with facility representative Zoe Teeter, the applicant/licensee is requesting a license for 34 infant, 24 toddlers with a total capacity of 58 children in room #1 & 2. The facility will operate Monday-Friday, 8:00 am to 5pm. The facility has 2 rooms, with 2 bathrooms for children and 2 bathrooms for staff. We have received an approved fire clearance for the 34 infants on 02/27/2024.
Children will nap on cots/mats in each classroom. There are sufficient number of mats to meet the capacity. The outdoor play area is not fenced and has not been set up; this will be required before licensing. There is one yard and the applicant is requesting for it to be shared between the infants and the toddlers. The yard measures 3,000 sq ft according to where the applicant said the fence will be installed, This is enough for 40 children.
There is a separate nap room in room #1 for infants. There are currently 8 cribs set up. An infant capacity worksheet was completed during the visit. There is enough indoor space (1352.32 square ft) for 38 infants in room #1 with 2 toilets and 2 sinks for the children.
A toddler capacity worksheet was completed during the visit. There is enough indoor space (361.3 square ft) for 10 toddlers in room #2 with 1 toilet, 1 urinal and 2 sinks for the toddlers. Based on the above, the maximum capacity of the facility could be 10 toddlers.
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Jaime Snow
LICENSING EVALUATOR SIGNATURE: DATE: 03/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 MONARCHS
FACILITY NUMBER: 493010486
VISIT DATE: 03/05/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
There is enough indoor space for 48 children (10 toddlers/38 infants).
Based on the above, the maximum capacity of the facility could be 38 infants. Based on the above, the maximum capacity of the facility could be 48 infant/toddlers total.
The indoor and outdoor activity spaces were toured, and a new sketch was received and verified at the inspection. The following areas will be off limits to children: the hallway leading to the staff bathroom which is inaccessible by locked door.
The facility does not provide any meals or snacks. The isolation area for sick children will be located in the office. There is safe and age-appropriate furniture, toys, and play equipment available for children. There is no pool, spa, pond, fountain, or any other body of water on the premises The poisons are locked in the janitor’s closet. Zoe Teeter, said there are no weapons on property.
Facility representative, Zoe Teeter, was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

This facility does not plan to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) tollfree ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Jaime Snow
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2024
LIC809 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 MONARCHS
FACILITY NUMBER: 493010486
VISIT DATE: 03/05/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA reviewed with facility representative, Zoe Teeter, the LIC 311A, Records to Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.
LPA discussed the safe sleep regulations with Zoe Teeter, facility representative and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep, as an additional resource.
LPA also informed facility representative, Zoe Teeter, of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: https://www.cpsc.gov/, and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
Representative, Zoe Teeter, was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the or facility representative, Zoe Teeter,
The following items need to be completed prior to the granting the license:
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Jaime Snow
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2024
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 MONARCHS
FACILITY NUMBER: 493010486
VISIT DATE: 03/05/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
1. Approval for the shared yard waiver & space waiver.
2. Managerial review, additional documents may be required
3. Install a play yard with fencing; send photos, an additional visit may be required
4. Proof of carbon monoxide detector
5. An original signature LIC200a (received at visit)
6. A6. Monthly Operating Statement (LIC 401) [101213(a)]
Income should be put under private and match the requested capacity/payroll tax should be 25% of wages.
7. A10. Personnel Record (LIC501) Needed for Carla/director
8. A14. Facility Sketch (floor plot plans- LIC 999 missing the following:
Room numbers & Isolation/sick area
Birdseye view showing what else is on the property, the entire building, where
parking/yards/classrooms are in relation to each other. Yard measurements (are there climbing structures or outbuildings)
9. B2. Verification of Director Qualifications missing the following for director/Carla: LIC 9096 Director Qualifications completed with proof of the following:
Education- Transcripts, course description, supervisory permit Transcripts include infant units for the infant and/or toddler component. Experience- written references
First Aid, CPR & Preventive Health Practices Training [101616.3(f)] EMSA approved.
First Aid, CPR & Preventive Health Practices Training [101616.3(f)] EMSA approved.
Orientation Training [101169(b)] in Operations and Record Keeping
Statement Acknowledging Requirement to Report Suspected Child Abuse (LIC 9108) [101212(d)(1)(D)] Mandated Reporter Training (AB1207) [H &S 1596.8662] continued list on the next page
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Jaime Snow
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2024
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 MONARCHS
FACILITY NUMBER: 493010486
VISIT DATE: 03/05/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Immunizations [H&S 1596.7995(a)(1)] Provides proof of Measles, Pertussis, and Influenza (decline declaration for
10. B3. Job Descriptions [101173(b)(5), 101217]
Need toddler teacher position (you may change the infant position to infant/toddler teacher or submit a separate toddler teacher description)
Director position needs to list who they report to (line of supervision) qualifications-missing infant and administration class, immunization/TB test/Mandated Reporter and preventive health practices training.
11. B6. Parent Handbook/Program Description/Admission Policies & Procedures/Discipline Policies [101169(a)-(f), 101218,
/ IMS plan (send if you plan to take IMS)
Provisions for infant safe sleep (infants only) to include infant napping log, LIC 9227, and infant sleeping equipment
Needs and Services Plans
12. B8. Admission Agreement [101173(b)(3), 101219] All of these items are in the handbook; however, this needs to be in a separate admission agreement that will be signed.
Description of basic services / Optional services / Payment provisions
Basic rate / Rate for optional services / Payor / Due date / Frequency of payments Modification conditions (30-day notification of any rate changes) / Refund policy
Rights of the licensing agency / Termination conditions / Toddler option statement included (written permission from the authorized representative is required). Signed and Dated by Director and Parent/Guardian
13. B10. List of Furniture & Play Equipment
You may want to update the list to match the new requested capacity.
14. Evidence of immunization against flu or written decline for licensee
(some of the above was provided at the inspection but still requires a review)
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Jaime Snow
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2024
LIC809 (FAS) - (06/04)
Page: 5 of 5