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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 283008881
Report Date: 10/07/2024
Date Signed: 10/07/2024 04:25:38 PM

Document Has Been Signed on 10/07/2024 04:25 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 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: 6DATE:
10/07/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:35 PM
MET WITH:Jacqueline WisniewskiTIME VISIT/
INSPECTION COMPLETED:
02:21 PM
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An unannounced case management inspection was made to the facility by Licensing Program Analyst (LPA) Mindy Mohr and Licensing Program Manager (LPM) Leslie Lepori to follow up on a Type A citation that was issued on 10/03/2024 in which the door to the bedroom where two infants were sleeping was closed. Upon arrival LPA observed a curtain hung in the doorway but no infants were asleep in the room. Licensee understands that when infants are asleep, the door and curtain must remain open at all times and staff must be able to visually observe the infant(s) without moving the door. A copy of the regulation was provided. LPA and LPM also observed six children in care with Licensee and one staff who left soon after CCL's arrival.

LPA cleared the Plan of Correction as of today 10/07/2024. No deficiencies cited today in areas observed.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melinda Mohr
LICENSING EVALUATOR SIGNATURE: DATE: 10/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/07/2024
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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