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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 490101256
Report Date: 01/24/2024
Date Signed: 01/24/2024 12:39:59 PM


Document Has Been Signed on 01/24/2024 12:39 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:PLEASANT HILL CASA DEI BAMBINIFACILITY NUMBER:
490101256
ADMINISTRATOR:MEGHAN MARKFACILITY TYPE:
850
ADDRESS:1000 GRAVENSTEIN HWY NTELEPHONE:
(707) 823-6003
CITY:SEBASTOPOLSTATE: CAZIP CODE:
95472
CAPACITY:26CENSUS: 20DATE:
01/24/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Meghan MarkTIME COMPLETED:
12:45 PM
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An unannounced case management inspection was conducted by Licensing Program Analyst (LPA) Selena Mariani for the purpose of RSO notification and to verify if an individual is associated with the facility. LPA met with Center Director (CD) Meghan Mark and discussed the purpose of the inspection. LPA toured the entire facility, and the individual was not present.

During today's inspection, LPA observed 20 children being supervised by 3 staff. LPA conducted an interview with CD, who stated she received a notification on the individual on 12/20/2023 and that the person has no association to the facility, CD or church. CD stated the individual is not a family member and does not know the person; never seeing them at the location.

Based on evidence obtained during today's visit, LPA has verified that the individual is not present, employed, or residing at the facility. The CD understands and is aware that an immediate $500 Civil Penalty will be assessed for having any adults work or live in the facility without background clearance. Verification has been completed. Exit interview conducted and report was reviewed with the Center Director, Meghan Mark. Notice of Site Visit shall be posted for 30 days from today's inspection. There were no Title 22 deficiency cited during today's inspection.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Selena MarianiTELEPHONE: (916) 605-8974
LICENSING EVALUATOR SIGNATURE:
DATE: 01/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/24/2024
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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