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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 233010923
Report Date: 05/28/2026
Date Signed: 05/28/2026 02:08:20 PM

Document Has Been Signed on 05/28/2026 02:08 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 CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:SUBLET, AMBER FCCHFACILITY NUMBER:
233010923
ADMINISTRATOR/
DIRECTOR:
AMBER SUBLETFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 621-4186
CITY:UKIAHSTATE: CAZIP CODE:
95482
CAPACITY: 14TOTAL ENROLLED CHILDREN: 16CENSUS: 16DATE:
05/28/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:43 AM
MET WITH:Gracey HayesTIME VISIT/
INSPECTION COMPLETED:
02:17 PM
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An annual random inspection was made to the facility by Licensing Program Analysts (LPAs), Robert Maciel-Kashima and Ivet Zamora Perez. LPAs met with Facility Representative, Gracey Hayes (S1). LS was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

During the inspection the home was toured inside and outside. Licensee, Amber Sublet (LS) was not present during todays visit. Facility Representative Gracey Hayes and another assistant were present, supervising 16 children, beyond the facility capacity of 14 children. Additionally, the facility did not possess documentation showing that any of the children present were school aged. S1 stated that LS was gone for the day and would return at around 3 p.m. S1 provided a current roster of children in care as required. The facility’s operating hours are Monday – Thursday 8:00 a.m. - 4:30 p.m.

The floor plan submitted by the licensee was reviewed and verified. The children have access to the classroom, the daycare bathroom, the driveway, and the outdoor play area. The side yard, backyard, kitchen, living room, all bedrooms, and bathroom 1 and 2 are off-limits, made inaccessible by door knob covers and gate latch.The home appears to be clean and orderly and was at a comfortable indoor temperature. There were safe toys and equipment available for children. There is a working telephone in the home. The facility representative’s pediatric CPR and First Aid certifications were reviewed and expires on 3/27/27.

Continued on LIC 809-C

NAME OF LICENSING PROGRAM MANAGER: Melchisedeck Augustin
NAME OF LICENSING PROGRAM ANALYST: Robert Maciel
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/28/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: SUBLET, AMBER FCCH
FACILITY NUMBER: 233010923
VISIT DATE: 05/28/2026
NARRATIVE
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Continued from LIC 809

Items which could pose a danger to children (such as detergents, cleaning compounds, medications, etc.) were observed to be stored out of the reach of children. LPAs observed that a container of Round Up pesticide was stored in the storage shed, out of reach, however, the door to the shed was unlocked and open. LPA observed a working smoke detector, carbon monoxide detector and a charged fire extinguisher, rated at least 2A10BC, in the home. The licensee has conducted an emergency drill within the past six months; last drill was documented on 2/4/26. Facility Representative stated she was unsure if firearms were stored in the home or not. LPAs did not observe any firearms. Five children's records were reviewed. Facility and personnel files were reviewed and contained required records.

On 5/18/26, Licensee notified LPA Maciel-Kashima of a newly constructed in-ground pool in the side yard of the home. During today's visit, LPAs reviewed the pool space which revealed that the fencing preventing access to the pool did not completely surround the pool area and was not a minimum of 5 feet high, the facility did possess a pool alarm that meets the ASTM F2208 standard but was not installed at the time of arrival, did not possess a 12 foot fixed-length body hook, did not possess a life ring with a label of approval by the United States Coast Guard, and did not possess a log of recorded daily inspections of pool safety features. Additionally, LPAs observed a hot tub in the back yard with a cover, however, it was not locked. LPAs opened the cover which revealed that the hot tub had a small amount of water remaining in it. The backyard was made inaccessible with a gate in the outdoor play area with a latch, however, the latch was not secured with a lock.

LPAs discussed the safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Continued on LIC809-C

NAME OF LICENSING PROGRAM MANAGER: Melchisedeck Augustin
NAME OF LICENSING PROGRAM ANALYST: Robert Maciel
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2026
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: SUBLET, AMBER FCCH
FACILITY NUMBER: 233010923
VISIT DATE: 05/28/2026
NARRATIVE
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Continued from LIC809-C

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514- 0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.



Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Facility Representative, confirmed that there are no Registered Sex Offenders living in the facility and LPAs completed the RSO profile in FAS.

The following violation(s) of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Appeal Rights were provided. Exit interview conducted and report was reviewed with Facility Representative Gracey Hayes. A notice of site visit was given and must remain posted on or immediately adjacent to the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

NAME OF LICENSING PROGRAM MANAGER: Melchisedeck Augustin
NAME OF LICENSING PROGRAM ANALYST: Robert Maciel
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2026
LIC809 (FAS) - (06/04)
Page: 4 of 9
Document Has Been Signed on 05/28/2026 02:08 PM - It Cannot Be Edited


Created By: Robert Maciel On 05/28/2026 at 12:10 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: SUBLET, AMBER FCCH

FACILITY NUMBER: 233010923

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 05/28/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(4)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. (A) Storage areas for poisons, firearms and other dangerous weapons shall be locked.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, a container of Roundup pesticide was stored in the storage shed in the side yard, out of reach, however, the door to the shed was unlocked and open which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/26/2026
Plan of Correction
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Licensee stated she would install a pad lock onto the gate that leads to the backyard from the outdoor play area and would send a picture of the secured gate to LPA by email at robert.maciel-kashima@dss.ca.gov by 6/26/26
Type B
Section Cited
HSC
1596.814(a)
Pool Safety
(a) A licensed family daycare home operated at a private single-family dwelling with an in-ground swimming pool on the premises shall comply with all of the following requirements:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the pool fencing preventing access to the pool did not completely surround the pool area and was not a minimum of 5 feet high, the facility did possess a pool alarm that meets the ASTM F2208 standard but was not installed at the time of arrival, did not possess a 12 foot fixed-length body hook, did not possess a life ring with a label of approval by the United States Coast Guard, and did not possess a log of recorded daily inspections of pool safety features which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/26/2026
Plan of Correction
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Facility representative stated Licensee would develop a plan for securing the in ground pool according to the requirements and would send the plan to LPA by email at robert.maciel-kashima@dss.ca.gov by 6/4/26 and proof of completion of the plan by 6/26/26.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Melchisedeck Augustin
NAME OF LICENSING PROGRAM MANAGER:
Robert Maciel
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/28/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/28/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/28/2026 02:08 PM - It Cannot Be Edited


Created By: Robert Maciel On 05/28/2026 at 12:10 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: SUBLET, AMBER FCCH

FACILITY NUMBER: 233010923

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 05/28/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(a)
Operation of A Family Child Care Home
(a) The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and staff statement, Licensee Amber Sublet (LS) was not present during todays visit. Facility representative Grace Hayes (S1) stated that LS was gone for the day and would return at around 3 p.m.which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/26/2026
Plan of Correction
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LPA Maciel-Kashima provided the regulations regarding the required hours the Licensee is required to be present in the home for. Licensee stated she would read the regulations and submit a written statement attesting to her understanding of the requirements to LPA by email at robert.maciel-kashima@dss.ca.gov by 6/26/26.
Type B
Section Cited
CCR
102416.5(d)(2)
Staffing Ratio and Capacity
(d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either: (2) More than twelve and up to fourteen children only if the criteria in Section 1597.465 of the Health and Safety Code are met.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, 16 children were present at the facility which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/26/2026
Plan of Correction
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Licensee stated she would develop a plan to reduce the number of children attending at the same time to an allowable level and would send the plan to LPA by 6/4/26 and would complete the plan by 6/26/26.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Melchisedeck Augustin
NAME OF LICENSING PROGRAM MANAGER:
Robert Maciel
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/28/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/28/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/28/2026 02:08 PM - It Cannot Be Edited


Created By: Robert Maciel On 05/28/2026 at 12:50 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: SUBLET, AMBER FCCH

FACILITY NUMBER: 233010923

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 05/28/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(5)
All licensees shall ensure the inaccessibility of pools (in-ground and above-ground), fixed-in-place wading pools, hot tubs, spas, fish ponds and similar bodies of water through a pool cover or by surrounding the pool with a fence.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, there is a hot tub in the back yard with a cover on it, however, it was not locked. LPAs opened the cover which revealed that the hot tub had a small amount of water remaining in it. The backyard was made inaccessible with a gate in the outdoor play area with a latch, however, the latch was not secured with a lock which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/26/2026
Plan of Correction
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Licensee stated she would make the hot tub inaccesible by adding a pad lock to the gate latch that separates the outdoor play area and the back yard and would send a picture of the secured gate to LPA by email at robert.maciel-kashima@dss.ca.gov by 6/26/26.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Melchisedeck Augustin
NAME OF LICENSING PROGRAM MANAGER:
Robert Maciel
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/28/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/28/2026


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