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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010486
Report Date: 10/21/2024
Date Signed: 10/21/2024 02:26:15 PM

Document Has Been Signed on 10/21/2024 02:26 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 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: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 27DATE:
10/21/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:21 PM
MET WITH:Zoe TeeterTIME VISIT/
INSPECTION COMPLETED:
02:40 PM
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On 10/21/2024, Licensing Program Analyst (LPA's) M. Mohr and S. Phouthavong arrived at the facility to conduct a case management inspection requested by Licensee, Zoe Teeter to verify the facility’s napping room and reviewed the requirements to the change in the rooms.

The facility was toured inside and outside. LPAs observed the rooms for the change and Licensee reviewed the plan for the change to LPAs. LPAs requested the facility to notify the department once the change has been competed and submit an updated facility sketch.

Exit interview conducted and report was reviewed with the Licensee, Zoe Teeter.

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

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

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE: DATE: 10/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/21/2024
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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