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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 283008881
Report Date: 04/08/2026
Date Signed: 04/08/2026 01:46:17 PM

Document Has Been Signed on 04/08/2026 01:46 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: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: 7DATE:
04/08/2026
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:40 PM
MET WITH:Jacqueline WisniewskiTIME VISIT/
INSPECTION COMPLETED:
02:05 PM
NARRATIVE
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During the course of a complaint investigation, additional deficiencies were identified. On 4/8/26, LPA met with licensee, Jacqueline Wisniewski (L1).

During parent interviews, it was revealed that L1 did not provide all reports documenting a Type A deficiency within a 12-month period to all parents of newly enrolled children for deficiencies cited on 12/19/24. Additionally, L1 did not permit parents to enter the family childcare home.

P1-P3 and P5 had children enrolled within 1 year of the Type A deficiency, but were not made aware of L1’s previous Type A citations, nor were they provided with the licensing reports. P1 stated that they do not recall signing a form [LIC 9224], and the only thing they remember was returning the contract and deposit to L1. P2 stated L1 gave them a photo album of parents saying how amazing her daycare was, but did not receive reports. P2 further stated if they had received the reports, their child would never have been put in L1’s care. P3 stated if they had been made aware of previous A citations, they wouldn’t have put their child in L1’s daycare. P5 stated they can’t recall for certain if they were made aware of L1’s previous A citations, but doesn’t think they were informed of the A citation.

NAME OF LICENSING PROGRAM MANAGER: Melinda Mohr
NAME OF LICENSING PROGRAM ANALYST: Jennifer Patel
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/08/2026
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.

LIC809 (FAS) - (09/23)
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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: WISNIEWSKI, JACQUELINE FCCH
FACILITY NUMBER: 283008881
VISIT DATE: 04/08/2026
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Furthermore, it was identified that parents are not allowed to enter the facility, P1 stated they originally had permission to be in L1’s entryway. However, after P1 informed L1 about the injuries to C1, L1 would just open the door and exchange C1 at the door. L1 told P1 that due to the high volume of drop-offs, it was faster and more efficient to drop off C1 at the door rather than come inside. P1 further stated that L1 said if P1 stood around, C1 would be more resistant to dropping off and the transition would be harder.

P2 stated they weren’t allowed to enter the house and said they were only allowed inside during the initial tour. P2 further stated L1 was very rude. During drop off, L1 would “snatch” the binky from C8’s mouth, say there was no contact inside the house for the kids' safety, and slam the door. In addition, P2 stated if they arrived too early L1 would get mad. P2 further stated C2 was not eating while in care, they were not allowed inside to see what was happening, further adding they could only exchange the children at the door.

P3 stated they weren’t invited into the house, and L1 would greet them at the door. P3 was invited in only once.

The following violations of the California Code of Regulations, Title 22; Division 12: see LIC 809D. Appeal rights were provided.

This report was reviewed and discussed with the licensee, Jacqueline Wisniewski. A Notice of Site Visit shall be posted for 30 days from today’s visit. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

NAME OF LICENSING PROGRAM MANAGER: Melinda Mohr
NAME OF LICENSING PROGRAM ANALYST: Jennifer Patel
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/08/2026 01:46 PM - It Cannot Be Edited


Created By: Jennifer Patel On 04/08/2026 at 12:53 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: WISNIEWSKI, JACQUELINE FCCH
FACILITY NUMBER: 283008881

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/08/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/24/2026
Section Cited
HSC
1596.8595

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(c)(1) A licensed child day care facility shall provide to the parents or guardians of each child receiving services in the facility copies of any licensing report that documents any Type A citation … (1) of subdivision (a) of Section 1596.893b. (2) Upon enrollment of a new child in a facility, the licensee shall provide to the parents or legal guardians of the newly enrolling child copies of any licensing report that the licensee has received during the prior 12-month period that documents any Type A citation ...
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L1 stated she will provide copies of the licensing reports documenting the Type A deficiency to all currently enrolled parents and provide an updated LIC 9224 to LPA Patel at jennifer.patel@dss.ca.gov.
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Based on LPA observation, record review, and interview 4 of 6 parents stated they did not receive licensing reports documenting a Type A citation upon enrolling in L1's daycare which poses a potential risk to the health, safety, and personal rights of persons in care.
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Type B
04/24/2026
Section Cited
CCR102419(e)

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1. (e)Upon presenting identification, the parent or authorized representative of a child in care has the right to enter and inspect the family childcare home without advance notice during the family childcare home's normal operating hours. This was not met as evidenced by:
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L1 stated that her assistant is usually the person who greets parents at pick up and drop off and that she had instructed her staff to welcome parents inside. L1 will ensure that parents are allowed inside at drop off and pick up, and provide training to her assistants. L1 will provide a signed declaration to LPA Patel at jennifer.patel@dss.ca.gov.
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Based on LPA interviews, 3 of 6 parents were not allowed entry into the daycare home during drop off and pick up which poses a potential risk to the health, safety, and personal rights of persons 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: 04/08/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/08/2026


LIC809 (FAS) - (06/04)
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