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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 280108300
Report Date: 11/06/2025
Date Signed: 11/06/2025 10:42:12 AM

Document Has Been Signed on 11/06/2025 10:42 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 CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:YELLOW BRICK ROAD #2FACILITY NUMBER:
280108300
ADMINISTRATOR/
DIRECTOR:		MICHELLE ALLENFACILITY TYPE:
850
ADDRESS:2211 FIRST STREETTELEPHONE:
(707) 255-1124
CITY:NAPASTATE: CAZIP CODE:
94559
CAPACITY: 37TOTAL ENROLLED CHILDREN: 50CENSUS: 25DATE:
11/06/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Michelle AllenTIME VISIT/
INSPECTION COMPLETED:
10:50 AM
NARRATIVE
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A Case Management inspection was conducted at the facility by Licensing Program Analyst (LPA) Jen Patel and Licensing Program Manager (LPM) Mindy Mohr in response to an Unusual Incident Report (UIR) received 10/30/2025 involving a child sustaining a head injury while in care. During today’s visit, LPA and LPM met with the facility’s director Michelle Allen (D1), to discuss the incident and obtain additional details. During today's case management visit, LPA and LPM observed 25 children in care being supervised by 3 staff. LPA and LPM toured the outdoor play area and observed a metal climbing dome up against a fence and a tree with a stump that had a sharp edge. The climbing dome is an age-appropriate piece of childcare equipment.

During the visit D1 reported that on 10/29/2025, she heard S1 call her name and said that C1 was bleeding. D1 stated that she was on the grassy area of the yard when the incident occurred but didn’t see the incident. Emergency personnel arrived to treat C1. D1 also called C1’s parents who decided to transport C1 to hospital to receive medical treatment. D1 further stated blood was observed on the tree stump.

S1 and S2 both stated they were on the yard at the time of the incident but did not observe C1 get injured. S1 further stated paramedics said C1 hit the tree stump with their forehead causing the injury.

Based on available information, it has been determined that adequate supervision was not provided on 10/29/25 when C1 received a injury on their head. The following violation of the California Code of Regulations, Title 22; Division 12, was observed: see LIC 809 Deficiency page. Appeal Rights were provided.

LPA provided handouts on Active Supervision to D1 during the visit.

A notice of site visit was given to D1 and must remain posted for 30 days.

Exit interview conducted and report was reviewed with facility representative, Michelle Allen.

NAME OF LICENSING PROGRAM MANAGER: Melinda Mohr
NAME OF LICENSING PROGRAM ANALYST: Jennifer Patel
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/06/2025
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.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 11/06/2025 10:42 AM - It Cannot Be Edited


Created By: Jennifer Patel On 11/06/2025 at 10:12 AM
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: YELLOW BRICK ROAD #2
FACILITY NUMBER: 280108300

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/05/2025
Section Cited
CCR
101229(a)(1)

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No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.

This requirement was not met as evidenced by:
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D1 stated the owner is receiving quotes to have the tree next to the dome and one other tree removed. D1 futher stated that she will review supervison handouts and have all staff sign off that they have reviewed. D1 will email a statement that all staff have completed review of supervision to LPA Jen at jennifer.patel@dss.ca.gov.
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Based on interview with D1, on 10/29/25 staff did not have visual supervision of C1 on the climbing dome that resulted in injury, which poses a potential risk to the health and safety or personal rights of children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Melinda Mohr
NAME OF LICENSING PROGRAM MANAGER:
Jennifer Patel
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 11/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/06/2025


LIC809 (FAS) - (06/04)
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