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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 283008881
Report Date: 10/29/2024
Date Signed: 10/29/2024 10:46:29 AM

Document Has Been Signed on 10/29/2024 10:46 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:WISNIEWSKI, JACQUELINE FCCHFACILITY NUMBER:
283008881
ADMINISTRATOR/
DIRECTOR:		WISNIEWSKI, JACQUELINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 306-2491
CITY:NAPASTATE: CAZIP CODE:
94558
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
10/29/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:02 AM
MET WITH:Jacqueline WisniewskiTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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An unannounced case management inspection was made to the facility by Licensing Program Analyst (LPA) Mindy Mohr to follow up on two Type B citations that were issued on 10/03/2024, in which the Assistant was supervising 11 children alone and Licensee could not furnish 15 minute sleep checks for two infants in care.
Upon LPAs arrival today there were 5 children present with another child arriving 1 minute later totaling 6 children. The Licensee was not home and the children were in the care of the Assistant. The facility was operating within ratio requirements. During the inspection LPA also requested copies of the 15 minute sleep checks, which upon review had been completed.

LPA cleared both Plan of Corrections as of today 10/29/2024. No deficiencies cited today in areas observed.


SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melinda Mohr
LICENSING EVALUATOR SIGNATURE: DATE: 10/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/29/2024
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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