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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493007605
Report Date: 01/15/2020
Date Signed: 01/15/2020 01:28:52 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:LYTTON RANCHERIA EDUCATION CENTERFACILITY NUMBER:
493007605
ADMINISTRATOR:MARIA BANUELOSFACILITY TYPE:
850
ADDRESS:1592 FULTON ROADTELEPHONE:
(707) 576-9272
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY:28CENSUS: 17DATE:
01/15/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Maria Banuelos, Site SupervisorTIME COMPLETED:
02:30 PM
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A subsequent case management inspection was conducted by Licensing Program Analyst (LPA) N. Cunningham regarding an unusual incident that was reported on 11/22/19. Child 1 (C1) informed a family member that Staff 4 (S4) was rude and hit her. C1 did not disclose any information to determine date of the alleged incident or who was around when the alleged incident occurred. During LPA's investigation, LPA obtained a roster of children in care, interviewed four staff members (S1-S4) and two children (C2-C3). LPA requested to interview C1 and C1’s parents; however, no interviews took place. No evidence was obtained to corroborate the allegation.

Notice of Site Visit shall be posted for 30 days from today's visit.

No deficiencies were cited as a result of this case management visit.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Nicolette CunninghamTELEPHONE: (707) 588-5056
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2020
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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