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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 283008506
Report Date: 06/20/2023
Date Signed: 06/20/2023 02:50:21 PM


Document Has Been Signed on 06/20/2023 02:50 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: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: 36DATE:
06/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Victoria SandovalTIME COMPLETED:
03:05 PM
NARRATIVE
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A required inspection was made to the facility by Licensing Program Analyst (LPA), Mindy Mohr. LPA met with Designation of Facility, Victoria Sandoval. The facility file was reviewed prior to this visit. A review of the personnel report on file indicates that all facility staff have received criminal record and child abuse index clearances or exemptions. Facility representative, Victoria Sandoval, was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

The facility’s operating hours are 7:00 am-6:00pm, Monday-Friday. The facility was toured inside and outside, and the floor and yard plan submitted by the licensee were verified. Sign in/out records were reviewed and in compliance. Items which could pose a danger to children (such as detergents, cleaning compounds and medications) were observed to be inaccessible to children. Facility representative stated there are no poisons in the facility, and none were observed during this inspection. LPA observed the toys, floors, desks and other equipment and surfaces are clean, toxic free, safe, and in good condition. There is uncontaminated drinking water available to children indoors and outdoors using a water pitcher and individual water bottles. The children's bathrooms are in safe and sanitary condition. The center’s isolation area for any child who becomes ill while in care is located in the staff office. Children bring their own snacks and lunch daily. There was no contaminated food observed. Garbage cans containing solid waste have tight fitting lids. There is a working carbon monoxide detector and fire extinguisher in the facility. LPA observed the playground equipment and surface areas were in safe condition. There is wood chip cushioning underneath play equipment to absorb falls. There were no bodies of water observed on the site. Facility representative stated no weapons are stored on site, and none were observed.

(continued on LIC 809-C)

SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melinda MohrTELEPHONE: (707) 494-2125
LICENSING EVALUATOR SIGNATURE:
DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/20/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 06/20/2023
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During today's inspection, staffing ratios were being met, 36 children were being supervised by 5 staff. The facility was operating within the licensed capacity and ratio requirements. At least one staff member present during the inspection Victoria Sandoval possessed current CPR and First Aid certifications, which expire 10/2024. Eight children’s records were reviewed and contained complete and current information as required. Five staff files were reviewed and contained all records as required.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

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

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 Director Shannon Daniels.

SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melinda MohrTELEPHONE: (707) 494-2125
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023
LIC809 (FAS) - (06/04)
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