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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 283008881
Report Date: 01/14/2025
Date Signed: 01/14/2025 11:29:58 AM

Document Has Been Signed on 01/14/2025 11:29 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: 8DATE:
01/14/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:16 AM
MET WITH:Jacqueline WisniewskiTIME VISIT/
INSPECTION COMPLETED:
11:35 AM
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Licensing Program Analyst (LPA) Mindy Mohr made an unannounced Plan of Correction (POC) visit and met with Licensee Jacqueline Wisniewski (L1) to follow up on two Type A deficiencies and one Type B deficiency that were cited on 12/19/2024. L1 was cited for placing children in cribs and cubbies as a way to calm down for 5-10 minutes as well as not ensuring children were being supervised at all times. L1 was also cited for not providing children with attention or comfort when children were upset.

During today’s visit, LPA counted 8 children in care being supervised by L1 and her Assistant (S1). The purpose of today’s POC visit is to get further clarification on L1’s Plan of Corrections. L1 stated she will submit written statements to the Department via email by 01/15/2025 with how she will comply with regulations regarding the citations received. L1 stated she has LPAs email.

There were no Title 22 deficiencies cited during today's inspection.

Exit interview conducted and report reviewed with Licensee, Jacqueline Wisniewski. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melinda Mohr
LICENSING EVALUATOR SIGNATURE: DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/14/2025
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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