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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493004164
Report Date: 03/21/2025
Date Signed: 03/21/2025 03:06:40 PM

Document Has Been Signed on 03/21/2025 03:06 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:BENNETT VALLEY MONTESSORI - PRESCHOOLFACILITY NUMBER:
493004164
ADMINISTRATOR/
DIRECTOR:		HEXTRUM, JEANNINEFACILITY TYPE:
850
ADDRESS:2810 SUMMERFIELD ROADTELEPHONE:
(707) 537-8889
CITY:SANTA ROSASTATE: CAZIP CODE:
95405
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 33DATE:
03/21/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:46 PM
MET WITH:Jeannine HextrumTIME VISIT/
INSPECTION COMPLETED:
03:10 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
During the course of a complaint investigation, a deficiency was identified involving the facility being out of ratio. Based on LPA’s observation at approximately 10:41am D1 was alone with 25 children in the main classroom for roughly 30 minutes during circle time. D1 stated two teachers were on break, one teacher was covering two other teacher breaks from the Preparatory classroom. D1 further stated another teacher left early for the day due to illness.

The following violation(s) of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Appeal Rights were provided.

Exit interview conducted and report was reviewed with Director, Jeannine Hextrum.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melinda Mohr
LICENSING EVALUATOR SIGNATURE: DATE: 03/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2025
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 2
Document Has Been Signed on 03/21/2025 03:06 PM - It Cannot Be Edited


Created By: Melinda Mohr On 03/21/2025 at 02:35 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: BENNETT VALLEY MONTESSORI - PRESCHOOL
FACILITY NUMBER: 493004164

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/21/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/04/2025
Section Cited
CCR
101216.3(a)

1
2
3
4
5
6
7
(a) There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance, except as specified in (b) and (c) below.
1
2
3
4
5
6
7
Director stated she will re-arrange staff schedules so they will be in ratio at all times. D1 stated she will email the new daily schedule to LPA at Melinda.mohr@dss.ca.gov no later than April 4, 2025.
8
9
10
11
12
13
14
This was not met as evidenced by:
Based on LPAs observation D1 was alone with 25 children during circle time for roughly 30 minutes in the main classroom.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Leslie Lepori
LICENSING EVALUATOR NAME:Melinda Mohr
LICENSING EVALUATOR SIGNATURE:
DATE: 03/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/21/2025


LIC809 (FAS) - (06/04)
Page: 2 of 2