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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 283008881
Report Date: 05/11/2023
Date Signed: 05/15/2023 08:22:50 AM


Document Has Been Signed on 05/15/2023 08:22 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:WISNIEWSKI, JACQUELINE FCCHFACILITY NUMBER:
283008881
ADMINISTRATOR:WISNIEWSKI, JACQUELINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 306-2491
CITY:NAPASTATE: CAZIP CODE:
94558
CAPACITY:14CENSUS: DATE:
05/11/2023
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Jacqueline Wisniewski - LicenseeTIME COMPLETED:
02:30 PM
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An informal conference was conducted today at 1:30 pm by Licensing Program Manager, Leslie Lepori, and Licensing Program Analyst, Melchisedeck Augustin, who met with Licensee, Jacqueline Wisniewski, to discuss the following items:

-The current status, census, staffing, and Licensee’s involvement in the facility.

-The outcomes of the complaint investigations in 2022 and the Licensee’s changes to the facility’s operation to ensure improved regulatory compliance.

-The use of the “cubby” for quiet or thinking time as well as children’s transition time upon entry or departure from the facility. Licensee reassured children are not left in the cubby for any extended period of time and are under supervision during the use of the cubby. Other separate rooms or bedrooms are not utilized for quiet time unless it is for napping time.

-Compliance with safe sleep regulation to include Licensee’s understanding of napping equipment and environment; conducting 15-minute checks for infants in care; assurance children who fall asleep are timely transferred to acceptable sleep equipment; keeping door open for observation; ensuring a peaceful environment and reasonable level of white noise used to calm children; not forcing a child to sleep and/or allowing awake children into the play area. (Continue to LIC 809-C)
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:
DATE: 05/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/12/2023
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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: WISNIEWSKI, JACQUELINE FCCH
FACILITY NUMBER: 283008881
VISIT DATE: 05/11/2023
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-Requirement for licensing reports to be posted and/or provided to the authorized representative as well as reporting requirements.

-The use of a camera system and pictures or videos taken to keep authorized representatives informed and maintain open communication and transparency, including when a child is injured.

-The parties ongoing collaboration to ensure Licensee’s regulatory compliance to provide a safe and healthful environment for children in care and acceptance of recommendations following complaint findings or inspections.

The parties acknowledged the issues discussed in which the facility has taken positive steps to address. This report was provided to the Licensee who signed the document which will be kept on file.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023
LIC809 (FAS) - (06/04)
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