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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 283008656
Report Date: 01/21/2025
Date Signed: 01/21/2025 10:58:13 AM

Document Has Been Signed on 01/21/2025 10:58 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:PAVON, SANDRINE FCCHFACILITY NUMBER:
283008656
ADMINISTRATOR/
DIRECTOR:
FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 8DATE:
01/21/2025
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:59 AM
MET WITH:Sandrine Pavone TIME VISIT/
INSPECTION COMPLETED:
11:08 AM
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A case management inspection was conducted to the facility by Licensing Program Analyst (LPA) Mindy Mohr in response to an increase in capacity application received by the Department on 10/07/2024. The licensee is requesting a capacity of 14. The licensee stated she clearly understands the maximum number of children for whom care can be provided and the limitations on the number of infants (birth to age 2) that may be cared for and when two of the children in care must be school aged, and when an assistant provider must be present. The licensee understands if no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. The facility was toured inside and outside, LPA reviewed assistants file which contained all required documents. The facility’s operating hours are 9:00 AM to 2:00 PM, Monday – Thursday.

The floor plan submitted by the licensee was reviewed and verified. The off-limits areas of the home are the three bedrooms, office, garage and backyard. These areas were made inaccessible by door knob covers, and a child safety gate. The Licensee and children will use the park for outdoor play, which is located directly across the street from the home. There is a working smoke detector, carbon monoxide detector and fire extinguisher in the home. The fire alarm is located in the preschool room. The Napa Fire Department inspected and granted the fire clearance on 01/09/2025.

The increase capacity to 14, as a Large Family Child Care Home is granted as of today, 01/21/2025.

There were no violations of Title 22 Regulations cited during today's visit.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melinda Mohr
LICENSING EVALUATOR SIGNATURE: DATE: 01/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/21/2025
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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