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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 480102614
Report Date: 07/22/2026
Date Signed: 07/22/2026 03:00:20 PM

Document Has Been Signed on 07/22/2026 03:00 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:ST. BASIL'S PRESCHOOLFACILITY NUMBER:
480102614
ADMINISTRATOR/
DIRECTOR:		BUTLER, LISAFACILITY TYPE:
850
ADDRESS:1225 TUOLUMNE STREETTELEPHONE:
(707) 642-5966
CITY:VALLEJOSTATE: CAZIP CODE:
94590
CAPACITY: 44TOTAL ENROLLED CHILDREN: 4CENSUS: 35DATE:
07/22/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:13 AM
MET WITH:Lisa ButlerTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
NARRATIVE
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On 7/22/26 at 10:11am, Licensing Program Analyst (LPA), Dianne Allee made an unannounced visit for the purpose of conducting an annual/random inspection. LPA met with facility Director, Lisa Butler. Director was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

St. Basil's Preschool operating hours are 7:30am to 5:30pm, Monday through Friday. This program is a preschool program which operates with two large classrooms. There is an upper and lower classroom. The restrooms are located at the far end of the upper classroom. The children's sinks are located just outside of the rest room. The facility was toured inside and outside, and the floor and yard plan reviewed. Sign in/out records were reviewed and in compliance. Items which could pose a danger to children (such as detergents, cleaning compounds and medications) were observed to be accessible to children. The director stated there are no poisons in the facility, and none were observed during this inspection. Director also stated there are no firearms or weapons stored on site. LPA observed the counters, toys, floors, desks and other equipment are clean, safe, and in good condition.

There is uncontaminated drinking water available to children indoors and outdoors, and the children have personal water bottles to drink from. The children's bathrooms are in safe and sanitary condition. The center’s isolation area for any child who becomes ill while in care is located in the Director's office. There is a working smoke detector, carbon monoxide detector and fire extinguisher rated at least 2A10BC in the facility.

LPA observed the playground equipment and surface areas were in safe condition. Rubberized chips under the climbing structure is used to absorb falls. There were no bodies of water observed on the site.

Continued on LIC809-C

Melinda Mohr
Dianne Allee
DATE: 07/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/22/2026
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: ST. BASIL'S PRESCHOOL
FACILITY NUMBER: 480102614
VISIT DATE: 07/22/2026
NARRATIVE
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PAGE 2

During today's inspection, staffing ratios were being met, a total of 35 preschool children were being supervised by the director, 2 teachers, and one aide. The facility was operating within the licensed capacity and ratio requirements. All staff on site today possess current CPR and First Aid certifications which were valid through 8/2028.

Five children’s (C1-C5) records were reviewed. C1-C3 did not contain all required documents. Four staff files were reviewed and contained all records as required.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPA verified that the lead testing was completed in accordance wtih the Written Directives outlined in PIN 21-21.1-CCP. Last testing was conducted 09/2022.

This facility provides Incidental Medical Services (IMS). The facility currently provides IMS for one child, and medication was not stored properly. Additionally, the facility could not provide a written IMS plan for that child. For IMS information see PIN 22-02-CCP, which was provided to the facility. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/ .

The Director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies throughout California.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Continued on LIC809-C

NAME OF LICENSING PROGRAM MANAGER: Melinda Mohr
NAME OF LICENSING PROGRAM ANALYST: Dianne Allee
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2026
LIC809 (FAS) - (06/04)
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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: ST. BASIL'S PRESCHOOL
FACILITY NUMBER: 480102614
VISIT DATE: 07/22/2026
NARRATIVE
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PAGE 3

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.

Exit interview conducted and report was reviewed with the Director, Lisa Butler.

LPA informed Director, Lisa Butler, that this report dated 7/22/2026 documents a LIC 809-D Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA informed the Director to provide a copy of this licensing report dated 7/22/2026 that documents any Type A citations 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 enrolled 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.

NAME OF LICENSING PROGRAM MANAGER: Melinda Mohr
NAME OF LICENSING PROGRAM ANALYST: Dianne Allee
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2026
LIC809 (FAS) - (06/04)
Page: 4 of 7
Document Has Been Signed on 07/22/2026 03:00 PM - It Cannot Be Edited


Created By: Dianne Allee On 07/22/2026 at 01:44 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: ST. BASIL'S PRESCHOOL
FACILITY NUMBER: 480102614

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/22/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101226(e)(1)(A)
Health-Related Services
(e) In centers where the licensee chooses to handle medications: (1) All prescription and nonprescription medications shall be centrally stored in accordance with the requirements specified below: (A) Medications shall be kept in a safe place inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation during inspection, the facility did not comply with the section cited above by storing prescription and non-prescription medications in an unlocked drawer in the classroom, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/23/2026
Plan of Correction
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Director immediately removed medications and stored them in the Director's office, which is inaccessible by child safety gates and door locks. Director and Assistant Director should read and discuss the regulation on storage of medications. Both Director and Assistant Director will write a statement and sign it with date, attesting they understand the regulation. Please email this to LPA Allee at dianne.allee@dss.ca.gov
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:
Dianne Allee
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/22/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/22/2026


LIC809 (FAS) - (06/04)
Page: 5 of 7
Document Has Been Signed on 07/22/2026 03:00 PM - It Cannot Be Edited


Created By: Dianne Allee On 07/22/2026 at 01:44 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: ST. BASIL'S PRESCHOOL
FACILITY NUMBER: 480102614

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/22/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101226(e)(1)(B)
Health-Related Services
(e) In centers where the licensee chooses to handle medications: (1) All prescription and nonprescription medications shall be centrally stored in accordance with the requirements specified below: (B) Each container shall have an unaltered label.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation, the facility did not comply with the section cited above in one out of one child's medication. C7 is currently on prescription medication that was stored without the container with prescription label on it. The medication also had an expiration date of 12/25. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/05/2026
Plan of Correction
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Director will obtain a new medication from the parent or guardian of C7. When storing the medication, the box with prescription label will be included. When the director obtains these items, please take a picture and email it to LPA Alee at dianne.allee@dss.ca.gov.
Type B
Section Cited
CCR
101220(a)
Child's Medical Assessments
(a) Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health-related services to the child.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on the record review of C1-C5, the facility did not comply with the section cited above in three of five (C1-C3) children's files that did not include LIC701, Physician Report. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/05/2026
Plan of Correction
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The director will obtain LIC 701, physician report for C1, C2, and C3. Once obtained, please email them to LPA Allee at dianne.allee@dss.ca.gov.
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:
Dianne Allee
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/22/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/22/2026


LIC809 (FAS) - (06/04)
Page: 6 of 7
Document Has Been Signed on 07/22/2026 03:00 PM - It Cannot Be Edited


Created By: Dianne Allee On 07/22/2026 at 01:44 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: ST. BASIL'S PRESCHOOL
FACILITY NUMBER: 480102614

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/22/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101226(e)(5)
Health-Related Services
(5) The licensee shall develop and implement a written plan to record the administration of prescription and nonprescription medications and to inform the child's authorized representative daily when such medications have been given.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation, the facility did not comply with the section cited above in one out of one child's incidental medical service. The facility did not possess a written plan for C6, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/05/2026
Plan of Correction
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Director and Assistant Director will review PIN 22-02-CCP (provided by LPA at the time of inspection). Using the PIN as a guide, will create a written plan for administering medication in an incidental medical services (IMS) plan for C6. When complete, please email to LPA at dianne.allee@dss.ca.gov
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:
Dianne Allee
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/22/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/22/2026


LIC809 (FAS) - (06/04)
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