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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 283008506
Report Date: 11/03/2023
Date Signed: 11/03/2023 09:28:25 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/03/2023 and conducted by Evaluator Melinda Mohr
COMPLAINT CONTROL NUMBER: 01-CC-20231003091834
FACILITY NAME:A PLACE OF MY OWNFACILITY NUMBER:
283008506
ADMINISTRATOR:SHANNON DANIELSFACILITY TYPE:
850
ADDRESS:2590 FIRST STREETTELEPHONE:
(707) 224-8667
CITY:NAPASTATE: CAZIP CODE:
94558
CAPACITY:52CENSUS: 22DATE:
11/03/2023
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Shannon DanielsTIME COMPLETED:
09:35 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is not complying with fire code
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Mindy Mohr conducted an unannounced subsequent complaint investigation visit and met with Director, Shannon Daniels (D1) to deliver the finding regarding the above allegation. LPAs Mindy Mohr and Cindy Castro previously met with D1 on 10/04/23 to open the complaint. It was alleged the facility is not complying with fire code.

During the course of the investigation, LPA Mohr toured the facility, made observations, obtained documents, and conducted interviews with staff and fire inspection professionals. LPA Mohr observed a physical address on the front of the building and a sign on the front fence of the facilities play yard identifying the preschool’s location. Both are legible and visible from the parking lot. Interviews revealed the annual fire alarm system inspection report from 01/09/23 was not available upon initial request. LPA Mohr obtained the inspection report from the facility which showed two items did not meet the inspection criteria. D1 stated the two items which did not meet the inspection criteria were corrected following the inspection.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melinda Mohr
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 01-CC-20231003091834
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: A PLACE OF MY OWN
FACILITY NUMBER: 283008506
VISIT DATE: 11/03/2023
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
26
27
28
29
30
31
32
 A recent fire alarm inspection resulted in the facility not passing but the items were promptly corrected, and a subsequent test resulted in the passing of the fire alarm system on 10/26/23. It was further confirmed that the address met fire clearance standards.

Based on the information gathered during this investigation, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegation occurred and therefore is determined to be unsubstantiated. There were no Title 22 deficiencies cited. This report was reviewed and discussed with the facility’s Director, Shannon Daniels. Appeal rights were provided. Notice of Site Visit shall be posted for 30 days from today's visit.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melinda Mohr
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2