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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173010039
Report Date: 07/17/2023
Date Signed: 07/17/2023 10:20:19 AM

Document Has Been Signed on 07/17/2023 10:20 AM - 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: DATE:
07/17/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Sara HansonTIME COMPLETED:
10:30 AM
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On 07/17/2023, Licensing Program Analyst, Sebastian Phouthavong made an announced Case Management visit to the facility and met with Licensee, Sara Hanson, regarding the facility's status becoming active. Prior, on 03/30/2023, Licensee has contacted LPA requesting the change of status. There are currently two adults living in the home.

During the visit, LPA toured the home inside and outside. An updated floor plan submitted by the licensee was reviewed and verified. The children have access to parts of the barn including the childcare room, one bathroom and the back yard. The main section of the barn is off-limits and made inaccessible to daycare children. The home appears to be clean and orderly and was at a comfortable indoor temperature. There were safe toys and equipment available for children. There is a working telephone in the home. The licensee’s pediatric CPR and First Aid certifications were reviewed and expire on 07/2024. Items which could pose a danger to children (such as detergents, cleaning compounds, medications, etc.) were observed to be stored out of the reach of children. Licensee stated that no poisons are stored in the home, and none were observed during today's inspection. LPA observed a working smoke detector, carbon monoxide detector and fire extinguisher, rated at least 2A10BC, in the home. LPA reviewed file and received.

Licensee stated she plans to provide care in on 08/01/2023 and that a fire safely inspection has been conducted to only the on-limits area of the barn.

Licensee has met the requirements to become active.

Exit interview conducted and report was reviewed with the licensee, Sara Hanson.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE: DATE: 07/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/17/2023
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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