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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173010033
Report Date: 11/16/2023
Date Signed: 11/16/2023 01:52:59 PM

Document Has Been Signed on 11/16/2023 01:52 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:BOHAN, NAHANI FCCHFACILITY NUMBER:
173010033
ADMINISTRATOR:BOHAN,NAHANIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 287-0551
CITY:KELSEYVILLESTATE: CAZIP CODE:
95451
CAPACITY: 14TOTAL ENROLLED CHILDREN: 15CENSUS: 7DATE:
11/16/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Nahani BohanTIME COMPLETED:
02:00 PM
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On 11/16/2023, at 12:35PM, Licensing Program Analyst, Sebastian Phouthavong made an announced Case Management visit to the facility and met with Licensee, Nahani Bohan to verify operation at the facility and to address the home’s swimming pool. Prior to visit, Licensee has submitted the required pictures, videos, and an updated facility sketch of the home.

During the visit, LPA observed 7 children in care being supervised by 2 staff. The entire home was toured inside and out. The on-limits daycare building is fully fence, which is used for daycare operation, making the pool inaccessible to children. Furthermore, the daycare building's back door has a lock latch that was observed to be in use during today’s inspection. The pool is surrounded by a 5ft fence in conjunction with the daycare building. LPA observed home's gates are meeting requirements. In addition, the front yard of the daycare building is fully fence as well. The main section of the home, where residences reside, is not in any way part of the daycare. Licensee will ensure to contact the department prior to making any changes to the home. Licensee also reviewed the importance of supervision and to ensure proper supervision is being provided when the swimming pool is in use.

LPA observed that the facility has met the fencing requirements for any bodies of waters as of today’s visit.

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

Exit interview conducted and report was reviewed with the Licensee, Nahani Bohan.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2023
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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