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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173010039
Report Date: 10/28/2022
Date Signed: 10/28/2022 02:26:20 PM

Document Has Been Signed on 10/28/2022 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:HANSON, SARA FCCHFACILITY NUMBER:
173010039
ADMINISTRATOR:HANSON, SARAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 245-5225
CITY:KELSEYVILLESTATE: CAZIP CODE:
95451
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
10/28/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Sara HansonTIME COMPLETED:
02:30 PM
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On 10/28/2022, Licensing Program Analyst (LPA), Sebastian Phouthavong made an unannounced Plan of Correction (POC) inspection at the facility. On 10/04/22, the facility was cited due to the facility operating over capacity. The Licensee submitted several POCs to clear several all violations. LPA met with Licensee, Sara Hanson and discussed the propose of the visit.

During today's inspection, LPA toured the facility inside and out and observed no children in care. Licensee was in compliance and operating with the capacity and ratio requirements.

During the visit Licensee submitted a LIC9211 Inactive request to LPA. Licensee is requesting to become inactive between 11/01/2022 through 06/30/2023. Licensee states she is using that time to focus on other educational fields and her daily schedule. Licensee stated she plans to update her Family Child Care operation and will contact CCL of an updates.

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 the licensee, Sara Hanson

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

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE: DATE: 10/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/28/2022
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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