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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483010481
Report Date: 06/09/2026
Date Signed: 06/09/2026 01:41:49 PM

Document Has Been Signed on 06/09/2026 01:41 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:BAYNORTH LEARNING CENTER - PRESCHOOLFACILITY NUMBER:
483010481
ADMINISTRATOR/
DIRECTOR:		LYSANDREA JACKSONFACILITY TYPE:
850
ADDRESS:2100 PENNSYLVANIA AVENUETELEPHONE:
(707) 720-5278
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 53TOTAL ENROLLED CHILDREN: 53CENSUS: 17DATE:
06/09/2026
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:36 AM
MET WITH:Lysandrea JacksonTIME VISIT/
INSPECTION COMPLETED:
02:01 PM
NARRATIVE
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On 06/09/26, Licensing Program Analyst (LPA), Jessica Gaumann made an unannounced Case Management visit to the facility and met with Director (D1), Lysandrea Jackson to address the facility's Plan of Correction (POC) due on 06/08/26. Prior to visit, LPA conducted an inspection on 05/18/26, where the facility received 2 Type B Deficiencies regarding teacher-child ratio and 1 Type B Deficiency regarding co-mingling.

During the inspection the facility was toured inside and outside. Upon arrival, LPA observed one fully qualified staff and one volunteer supervising 17 preschool children. One volunteer record was reviewed and was incomplete.

Per confirmation of D1 and one staff, there was a new staff member working at the facility on 06/08/26 who did not have a criminal record clearance.

Two Plan of Corrections have been met, and the deficiencies cleared. Letters of Deficiency Citations Cleared were provided. One Deficiency regarding co-mingling has been extended to 06/16/26.

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

NAME OF LICENSING PROGRAM MANAGER: Melinda Mohr
NAME OF LICENSING PROGRAM ANALYST: Jessica Gaumann
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/09/2026
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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Document Has Been Signed on 06/09/2026 01:41 PM - It Cannot Be Edited


Created By: Jessica Gaumann On 06/09/2026 at 11:43 AM
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: BAYNORTH LEARNING CENTER - PRESCHOOL
FACILITY NUMBER: 483010481

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/09/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/16/2026
Section Cited
CCR
101216.3(a)

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CCR 101216.3(a) Teacher-Child Ratio. There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance.

This requirement was not met as evidenced by:
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Director (D1) stated she will only accept 12 children into the preschool program until another qualifed teacher or aide is hired and will submit a written statement verifying this to LPA Gaumann via email: jessica.gaumann@dss.ca.gov
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Based on observation and interviews, one teacher and one volunteer were supervsing 17 preschool children at one time which poses a potential risk to the health, safety, and personal rights of persons in care.
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Type B
06/16/2026
Section Cited
CCR101170(e)(1)

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101170(e)(1) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department.

This requirement is not met as evidenced by:
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Director (D1) stated that the new staff member resigned this morning. D1 will sumbit a written statement of how facility will comply with this regulation moving forward to LPA Gaumann via email: jessica.gaumann@dss.ca.gov
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Based on interview and record review, one new staff worked at the facility on 06/08/26 without an associcated criminal record clearance, which poses an immediate health & safety and personal rights risk to the children 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:
Jessica Gaumann
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/09/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/09/2026 01:41 PM - It Cannot Be Edited


Created By: Jessica Gaumann On 06/09/2026 at 12:01 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: BAYNORTH LEARNING CENTER - PRESCHOOL
FACILITY NUMBER: 483010481

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/09/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/16/2026
Section Cited
CCR
101217(b)(1)

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101217(b)(1)(2) Personnel records shall be maintained for all volunteers and shall contain the following: (1) A health statement

This requirement was not met as evidenced by:
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Director (D1) stated she will get a health statement for volunteer on file and submit a written statement that staff file contains health statement due to staff confidentiality to LPA Gaumann via email: jessica.gaumann@dss.ca.gov
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Based on record review, one volunteer did not have a health statement on file which poses a potential risk to the health, safety, and personal rights of persons in care.
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Type B
06/16/2026
Section Cited
CCR101217(b)(2)

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101217(b)(1)(2) Personnel records shall be maintained for all volunteers and shall contain the following...(2) Tuberculosis test

This requirement was not met as evidenced by:
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Director (D1) stated she will get a Tuberculosis test for volunteer on file and submit a written statement that staff file contains Tuberculosis test due to staff confidentiality to LPA Gaumann via email: jessica.gaumann@dss.ca.gov
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Based on record review, one volunteer did not have a Tuberculosis Test on file 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:
Jessica Gaumann
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/09/2026


LIC809 (FAS) - (06/04)
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