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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 283010138
Report Date: 07/11/2024
Date Signed: 07/11/2024 01:52:17 PM

Document Has Been Signed on 07/11/2024 01:52 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:HOPPER CREEK MONTESSORIFACILITY NUMBER:
283010138
ADMINISTRATOR/
DIRECTOR:		TAMARA KINMANFACILITY TYPE:
850
ADDRESS:2141 2ND STREETTELEPHONE:
(707) 231-8768
CITY:NAPASTATE: CAZIP CODE:
94559
CAPACITY: 35TOTAL ENROLLED CHILDREN: 35CENSUS: 17DATE:
07/11/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:34 AM
MET WITH:Tamara KinmanTIME VISIT/
INSPECTION COMPLETED:
02:04 PM
NARRATIVE
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An unannounced case management visit was made by Licensing Program Analyst (LPA) Mindy Mohr to follow up on an Unusual Incident Report (UIR) submitted to CCL on 07/03/2024. LPA met with Director Tamara Kinman today to discuss the incident. The facility reported that on 07/03/3024 a staff member (S1) was with two children on the floor when one child (C1) tried to bite S1. S1 stated very loudly “do not bite” and then picked up/pulled C1 in a rough manner and then placed C1 away from them.

During today’s inspection LPA observed 17 children being supervised by 2 staff members. LPA conducted staff interviews, made observations and received copies of facility documents. During the visit LPA identified an elementary school age child (C2) co-mingling with the preschool children while eating lunch. Staff interviews revealed that C2 is going into fourth grade and has previously attended the facility during Christmas break and Spring Break for a few hours at a time when their school is closed for the holidays. In addition, staff interviews revealed that C2 has attended the facility every morning this week, but has been picked up by 1:00 pm.

The following violation(s) of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Appeal Rights were provided

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.

Exit interview conducted and report was reviewed with Director, Tamara Kinman.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melinda Mohr
LICENSING EVALUATOR SIGNATURE: DATE: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/11/2024
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 10/07/2024 11:52 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 09/18/2024 12:17 PM


Created By: Melinda Mohr On 07/11/2024 at 01:13 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: HOPPER CREEK MONTESSORI
FACILITY NUMBER: 283010138

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/11/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/11/2024
Section Cited
CCR
101161(a)

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(a) A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation.
This requirement is not met as evidenced by:
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The facility director had the child picked up immediately and stated the child will not return to the facility for care.
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LPA observed one school aged child co-mingling with the preschool children while eating lunch, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
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Type B
07/11/2024
Section Cited
CCR101223(a)(1)

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(a)The licensee shall ensure that each child is accorded the following personal rights:
(1)To be accorded dignity in his/her personal relationships with staff and other persons.
This requirement is not met as evidenced by:
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The facility director stated that S1 was terminated that day.
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During interviews it was revealed that (S1) was with two children on the floor when (C1) tried to bite S1. S1 stated very loudly “do not bite” and then picked up/pulled C1 in a rough manner and then placed C1 away from them.
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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: 07/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/11/2024


LIC809 (FAS) - (06/04)
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