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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 490108746
Report Date: 08/23/2024
Date Signed: 08/23/2024 09:38:43 AM


Document Has Been Signed on 08/23/2024 09:38 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:CHILDREN'S CORNERFACILITY NUMBER:
490108746
ADMINISTRATOR:CICCHETTO, JANFACILITY TYPE:
850
ADDRESS:629 EAST D STREETTELEPHONE:
(707) 763-6191
CITY:PETALUMASTATE: CAZIP CODE:
94952
CAPACITY:100CENSUS: 40DATE:
08/23/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:12 AM
MET WITH:Jan CicchettoTIME COMPLETED:
09:48 AM
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Licensing Program Analyst (LPA) Robert Maciel made a visit to the facility for the purpose of collecting documents to clear plans of corrections for citations issued on 7/26/24. LPA met with Director Jan Cicchetto.

During today's visit, LPA observed 40 children in care. LPA reviewed Mandated Reporter training certificates for staff and lead test documents for the facility which revealed that the facility tested for lead contamination on 08/14/24 and that staff 1 (S1) possessed a current mandated reporter training certificate. LPA received a copy of the LIC9275 External Water Sampler Self-Certification Form, LIC9276 Child Care Center Sampling Checklist Form, and a map of the facility indicating which faucets were tested for lead contamination. Director stated that the sampler informed the director that the analysis should be uploaded by 9/10/24.

Exit interview conducted and report was reviewed with the Director, Jan Cicchetto. A notice of site visit was given and must remain posted for 30 days. No deficiencies were cited during today's visit.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Robert MacielTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2024
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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