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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173010033
Report Date: 10/13/2022
Date Signed: 10/13/2022 10:21:56 AM

Document Has Been Signed on 10/13/2022 10:21 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:BOHAN, NAHANI FCCHFACILITY NUMBER:
173010033
ADMINISTRATOR:BOHAN,NAHANIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 287-0551
CITY:KELSEYVILLESTATE: CAZIP CODE:
95451
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
10/13/2022
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Nahani BohanTIME COMPLETED:
10:30 AM
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On 10/12/2022 at 9:00am, Licensing Program Analyst (LPA), Sebastian Phouthavong made an announced
Case Management visit to the facility met with Licensee, Nahani Bohan; regarding an additional room added to the home. An updated facility sketch was submitted prior the visit.

During the visit, LPA toured the facility and observed four children being supervised by two staff members. LPA observed the added room and includes a living room, playroom, one bedroom, kitchen, one bathroom. The children will have access to entire added room, side yard and front yard. The off-limits areas of the home include the entire right side of the home, garage, and back yard. There were safe toys and equipment available for children. LPA observed a working smoke detector, carbon monoxide detector and fire extinguisher, rated at least 2A10BC, in the home. Licensee stated she plans to manly use the added room during operating hours. The added room as completed a county inspection on 08/23/2022.

During the visit, LPA reviewed pool Requirements with the licensee. With ponder review, LPA informed Licensee that the facility’s pool is currently not meeting pool Requirements/Building Code. Licensee stated plans to submit a waiver and plans fully fence the additional room making the backyard pool and entire left side of the home inaccessible. The Licensee sated temporarily she plans to lock the doors to the outside and , ensuing the area is inaccessible to the day care children.

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 the licensee, Nahani Bohan.

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

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE: DATE: 10/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/13/2022
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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