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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 283009162
Report Date: 09/11/2024
Date Signed: 09/11/2024 03:35:24 PM

Document Has Been Signed on 09/11/2024 03:35 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:LE PETIT ELEPHANT NURSERYFACILITY NUMBER:
283009162
ADMINISTRATOR/
DIRECTOR:		PAL PINTACSI, MILLIFACILITY TYPE:
830
ADDRESS:2645 LAUREL STREETTELEPHONE:
(707) 690-8797
CITY:NAPASTATE: CAZIP CODE:
94558
CAPACITY: 28TOTAL ENROLLED CHILDREN: 28CENSUS: 29DATE:
09/11/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:55 AM
MET WITH:Milli PintacsiTIME VISIT/
INSPECTION COMPLETED:
01:13 PM
NARRATIVE
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On 09/11/2024 Licensing Program Analysts (LPAs) Glenn Ouye and Mindy Mohr made an unannounced case management visit and met with Milli Pintacsi to conduct a capacity increase from 28 - 45 infants. The capacity change application was received on 07/12/2024. LPAs measured all rooms and advised Licensee final approval is pending approved fire safety clearance.

Upon arrival LPAs observed an infant (C1) asleep on their stomach in a crib. LPAs asked the infants age and to see the infant's LIC 9227 Individual Sleeping Plan. S1 stated the infant was almost 5 months old and has never observed the infant roll back to stomach. D1 stated the infant was observed by another teacher rolling today 09/11/2024 from back to stomach. Upon review of the LIC 9227, section C : Infants ability to roll was not completely filled out by C1's guardian. C1's guardian noted on the form the infant has been observed rolling stomach to back, but not back to stomach. Staff did not place the infant back in their original position on their back.

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

Exit interview was conducted which documents one Type A citation and was reviewed with Director, Milli Pintacsi who was informed that Type A citations shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

LPAs Mohr and Oyue informed the facility representative to provide a copy of this licensing report dated 09/11/2024 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolling parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

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: 09/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/11/2024
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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Document Has Been Signed on 09/11/2024 03:35 PM - It Cannot Be Edited


Created By: Melinda Mohr On 09/11/2024 at 01:40 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: LE PETIT ELEPHANT NURSERY
FACILITY NUMBER: 283009162

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/11/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/11/2024
Section Cited
CCR
101430(a)(3)(A)

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(A) Staff shall place infants up to 12 month of age on their backs for sleeping.

This requirement was not met as evidenced by:
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All staff have been given safe sleep regulations to read. Staff have all signed the safe sleep regulation and have an understanding of infant safe sleep.
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Based on LPA's observation an infant was in a crib, asleep on their stomach which poses an immediate health, safety or personal rights risk to 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.
SUPERVISOR'S NAME:Leslie Lepori
LICENSING EVALUATOR NAME:Melinda Mohr
LICENSING EVALUATOR SIGNATURE:
DATE: 09/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/11/2024


LIC809 (FAS) - (06/04)
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