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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173009037
Report Date: 04/18/2024
Date Signed: 04/18/2024 02:07:55 PM

Document Has Been Signed on 04/18/2024 02:07 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:PIKE, JANELL FCCHFACILITY NUMBER:
173009037
ADMINISTRATOR/
DIRECTOR:		PIKE, JANELLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 484-8119
CITY:HIDDEN VALLEY LAKESTATE: CAZIP CODE:
95467
CAPACITY: 14TOTAL ENROLLED CHILDREN: 22CENSUS: 10DATE:
04/18/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:50 PM
MET WITH:Janell PikeTIME VISIT/
INSPECTION COMPLETED:
02:20 PM
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On 04/18/2024, at 11:50AM, Licensing Program Analyst, Sebastian Phouthavong made an unannounced Case Management visit to the facility and met with Licensee, Janell Pike today and spoke with her regarding the visit. Through the course of an investigation that was not associated with the facility; it was alleged that the Licensee was not properly following the Community Care Licensing Requirements

During the inspection the home was toured inside and outside. The licensee and assistant were supervising 10 children and operating within the licensed capacity and ratio requirements. Licensee denied the allegation. LPA conducted interviews with Licensee, assistant and 2 children. Interviews conducted by daycare children had no concerns with the facility at this time.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee, Janell Pike.

There were no Title 22 deficiencies cited during today's inspection.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE: DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2024
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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