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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 490111042
Report Date: 02/01/2024
Date Signed: 02/01/2024 11:26:21 AM


Document Has Been Signed on 02/01/2024 11:26 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:RAINBOW GARDEN AT KENWOOD SCHOOLFACILITY NUMBER:
490111042
ADMINISTRATOR:DAWSON, JILLFACILITY TYPE:
850
ADDRESS:230 RANDOLPH AVENUETELEPHONE:
(707) 833-6551
CITY:KENWOODSTATE: CAZIP CODE:
95452
CAPACITY:15CENSUS: 7DATE:
02/01/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
10:51 AM
MET WITH:Jill DawsonTIME COMPLETED:
11:40 AM
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On 02/01/2024, Licensing Program Analyst (LPA), Mindy Mohr made a case management inspection and met with Director, Jill Dawson. The inspection was made in response to water lead testing results received from the facility. The test results showed that the following samples tested above the allowable level 5.0 parts per billion (ppb) of lead in the water: Sample Site A had a reading of 37 ppb. All other sources of water tested below the allowable level of 5.0 ppb.

During today’s inspection, LPA observed the hose bib to be replaced and fenced off making it inaccessible to day care children and staff. Director stated the facility has replaced the hose bib and water lines and will be having Sample Site A tested again.

During today’s inspection LPA requested the Child Care Center Sampling Checklist Form (LIC 9276) and Facility Sketch/Floor Plan (LIC 999). LPA requested that the facility provide the External Water Sampling Self-Certification Form (LIC 9275) and photos of all water outlets labeled and corresponding to the Facility Sketch (LIC 999).

The following deficiency is being cited (see LIC 809D). Appeal Rights were provided. 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 Jill Dawson.

SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melinda MohrTELEPHONE: (707) 494-2125
LICENSING EVALUATOR SIGNATURE:
DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/01/2024
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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