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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483005287
Report Date: 02/01/2023
Date Signed: 02/01/2023 05:12:26 PM


Document Has Been Signed on 02/01/2023 05:12 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:STENZ, PAULA FAMILY CHILD CARE HOMEFACILITY NUMBER:
483005287
ADMINISTRATOR:STENZ, PAULAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 469-9100
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY:14CENSUS: 11DATE:
02/01/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:56 PM
MET WITH:Paula StenzTIME COMPLETED:
05:30 PM
NARRATIVE
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A Case Management visit was made to the facility by Licensing Program Analyst (LPA), Amy Strother. LPA met with Licensee, Paula Stenz. The Case Management visit was conducted regarding the following: On 10/13/22 during a complaint investigation inspection, LPA Trinh requested and obtained 4 pages of form LIC9040 Child Care Facility Roster from Licensee, Paula Stenz (L1). On 12/14/22 LPA Strother received additional copies of form LIC9040 from L1 in a text message. One page of the LIC9040 sent to LPA Strother had been updated with an additional child (C5) who was not previously listed on the LIC9040 given to LPA Trinh.

Based on interviews conducted during the complaint investigation, it was corroborated a child, Child 3 (C3) who attended L1’s facility was also not listed on the LIC9040 provided by L1 to LPA Trinh or LPA Strother. When LPA Strother inquired with L1 by text message on 01/26/23 if a child by the name of “C3” attended her facility, L1 replied, “No, not that I remember.” Interviews conducted and documents reviewed corroborate that L1 omitted a child from the Child Care Roster LIC9040 and the roster was not current.

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 the licensee, Paula Stenz.

SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy StrotherTELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:
DATE: 02/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/01/2023
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 02/01/2023 05:12 PM - It Cannot Be Edited

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: STENZ, PAULA FAMILY CHILD CARE HOME
FACILITY NUMBER: 483005287

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/15/2023
Section Cited

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102417(g)
(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.


This requirement is not met as evidenced by:
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The Licensee will review files for previously enrolled children and record any missing information of the children formerly enrolled in care on the LIC 9040, and submit all pages of the completed facility roster to the Department by 02/15/23 via email or text. Email: amy.strother@dss.ca.gov or Text: 707-599-1479.
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Based on record review, the facility roster of the children currently and formerly enrolled in care was missing two children Child 3 (C3) and Child 5 (C5) and therefore incomplete. The licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
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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: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy StrotherTELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:
DATE: 02/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/01/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2