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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173010039
Report Date: 03/12/2025
Date Signed: 03/12/2025 01:59:40 PM

Document Has Been Signed on 03/12/2025 01:59 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/
DIRECTOR:		HANSON, SARAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 245-5225
CITY:KELSEYVILLESTATE: CAZIP CODE:
95451
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
03/12/2025
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Sara HansonTIME VISIT/
INSPECTION COMPLETED:
02:10 PM
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On 03/12/2025, Licensing Program Analyst, Sebastian Phouthavong has conducted Case Management Visit regarding Licensee requesting to add an additional rooms included in the home's barn. Today, LPA met with Licensee, Sara Hanson. Prior to visit, Licensee received a Fire Safely Inspection conducted by the local fire department and LPA received an approved STD 850 to include the additional rooms in the home's barn 02/26/2025. Also Licensee submitted an updated Facility Sketch to the department.

During the inspection the home was toured inside and outside. The licensee and three assistants were supervising 7 children and operating within the licensed capacity and ratio requirements. The facility’s operating hours are Monday - Friday, 7:30 AM - 5:30 PM. The children have access to parts of the barn including Existing Daycare Room, Middle Room, Back Room, 1 Bathroom and Black top area. The off-limits area include the main home, the barn's shed and the yard behind the barn. The off-limits areas of the home were made inaccessible by door locks, plastic doorknob covers and/or child gates


The Licensee has met the requirements for the additional rooms and has been approved.

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

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.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE: DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/12/2025
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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