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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483010798
Report Date: 05/12/2026
Date Signed: 05/12/2026 06:57:45 PM

Document Has Been Signed on 05/12/2026 06:57 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:FAIRFIELD PRESCHOOL & CHILDCAREFACILITY NUMBER:
483010798
ADMINISTRATOR/
DIRECTOR:		MONIKA VERMAFACILITY TYPE:
860
ADDRESS:1004 UTAH STREETTELEPHONE:
(901) 240-7791
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 44TOTAL ENROLLED CHILDREN: 11CENSUS: 8DATE:
05/12/2026
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:01 PM
MET WITH:Monika VermaTIME VISIT/
INSPECTION COMPLETED:
07:15 PM
NARRATIVE
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On 05/12/26 Licensing Program Analysts (LPAs) Jessica Gaumann and Amy Strother made an unannounced visit to the facility and met with Director (D1), Monika Verma.

During the visit, at 9:27am LPAs observed an infant (C1) strapped in a car seat. Staff 2 (S2) stated that C1 arrived sleeping in the car seat and remained there until C1’s diaper was changed. A review of the daily log stated the time C1 was fed milk as 8:20am. S2 stated she fed C1 while C1 was in the car seat. The daily log states the diaper change as 9:15am. S2 also stated that C1 is kept in the car seat to protect them from older infants in care. At 11:38am C1 was observed sleeping on a cushion on the floor. Minutes prior, D1 was observed feeding C1 while C1 was lying on the cushion on the floor. Based on interview at 11:48am, D1 stated she was planning to leave C1 sleeping on the floor because C1 is new and that is where C1 is comfortable and did not want to wake C1 up.

At 9:37am LPAs observed 7 cots stacked in the preschool room. 3 of the cots had sheets on them and the sheets were touching.

At 9:59am LPAs observed 4 out of 5 preschool children swinging on a swing set in the play yard. LPA Strother observed the play structure label which states “this swing set is intended for children ages 3 to 10.” 4 out of 5 of the preschool children present today were under 3 years old.

D1 provided a copy of LIC9040 Child Care Facility Roster to LPAs. LPAs observed 6 children’s birthdays missing and a dis-enrollment date for one child was not listed. Prior to end of the visit, D1 provided an updated roster.

Continued on LIC809-C

NAME OF LICENSING PROGRAM MANAGER: Melinda Mohr
NAME OF LICENSING PROGRAM ANALYST: Jessica Gaumann
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/12/2026
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 05/12/2026 06:57 PM - It Cannot Be Edited


Created By: Jessica Gaumann On 05/12/2026 at 04:14 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: FAIRFIELD PRESCHOOL & CHILDCARE
FACILITY NUMBER: 483010798

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/12/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/26/2026
Section Cited
CCR
101427(h)

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(h) Infants who are unable to hold a bottle shall be held by a staff person or other adult for bottle feeding. At no time shall a bottle be propped for an infant. An infant shall not be allowed to carry a bottle while ambulatory...

This requirement was not met as evidenced by:
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D1 will submit a written statement that she understands the regulation and has trained her staff that infants who are unable to hold a bottle shall be held by a staff person for bottle feeding to LPA Gaumann via email: jessica.gaumann@dss.ca.gov by 05/26/26
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Based on observation and interview, D1 was observed feeding C1 while C1 was lying on a cushion on the floor and S2 stated she fed C1 while C1 was strapped in the car seat, which poses a potential health, safety or personal rights risk to persons in care.
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Type B
05/26/2026
Section Cited
CCR101439(b)

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(b) The infant care center shall be equipped with appropriate furniture and equipment including, but not limited to, cribs, cots or mats; changing tables; and feeding chairs.

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D1 stated she will create a division of play space for the mobil infants and the immobil infants and send photo documentation to LPA Gaumann via email: jessica.gaumann@dss.ca.gov by 05/26/26
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Based on observation and interview, C1 was strapped in a car seat. During interview S2 stated that C1 is kept in the car seat to protect them from older infants in care, which poses a potential 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.
Melinda Mohr
NAME OF LICENSING PROGRAM MANAGER:
Jessica Gaumann
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/12/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/12/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/12/2026 06:57 PM - It Cannot Be Edited


Created By: Jessica Gaumann On 05/12/2026 at 04:40 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: FAIRFIELD PRESCHOOL & CHILDCARE
FACILITY NUMBER: 483010798

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/12/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/26/2026
Section Cited
HSC
1596.841

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1596.841 Child day care facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and telephone number of the child's physician.

This requirement was not met as evidenced by:
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D1 provided an updated roster to LPA during visit. D1 stated she will submit a written statement of how she will maintain a current roster of children moving forward to LPA Gaumann via email: jessica.gaumann@dss.ca.gov by 05/26/26
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Based on record review, 6 children’s birthdays missing and a dis-enrollment date for one child was not listed on LIC9040, which poses a potential health, safety or personal rights risk to persons in care.
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Type B
05/26/2026
Section Cited
CCR101239.1(c)(2)

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c) Each cot or mat shall be equipped with a sheet to cover the cot or mat...(2) Bedding shall be individually stored so that each child's bedding is identifiable and no child's used bedding comes into contact with other bedding.

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D1 stated she will begin to store child's bedding individually and submit a written statement of how she trained staff on the procedure to LPA Gaumann via email: jessica.gaumann@dss.ca.gov by 05/26/26
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Based on observation, 3 of the stacked 7 cots had sheets on them and were touching, which poses a potential 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.
Melinda Mohr
NAME OF LICENSING PROGRAM MANAGER:
Jessica Gaumann
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/12/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/12/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/12/2026 06:57 PM - It Cannot Be Edited


Created By: Jessica Gaumann On 05/12/2026 at 04:44 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: FAIRFIELD PRESCHOOL & CHILDCARE
FACILITY NUMBER: 483010798

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/12/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/26/2026
Section Cited
CCR
101239(m)

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(m) All play equipment and materials used by children shall be age-appropriate.

This requirement was not met as evidenced by:
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D1 stated she will provide documentation of the manufactures age rating for the equiptment and will remove the swings on the swing set and send photo documentation to LPA Gaumann via email: jessica.gaumann@dss.ca.gov by 05/26/26
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Based on observation and record review, the swing set is intended for ages 3 to 10. 4 out of 5 preschool children were observed using the swing set and 4 out of 5 preschool children present today were under the age of 3, which poses a potential 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.
Melinda Mohr
NAME OF LICENSING PROGRAM MANAGER:
Jessica Gaumann
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/12/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/12/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/12/2026 06:57 PM - It Cannot Be Edited


Created By: Jessica Gaumann On 05/12/2026 at 04:54 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: FAIRFIELD PRESCHOOL & CHILDCARE
FACILITY NUMBER: 483010798

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/12/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/13/2026
Section Cited
CCR
101430(a)(3)(E)

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(a)…(3) All infants shall be given the opportunity to sleep without distraction or disturbance from other activities at the center whenever the infant desires. (E) If an infant falls asleep before being placed in a crib, staff shall move the infant to a crib as soon as possible.

This requirement was not met as evidenced by:
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D1 stated she will submit a written plan of how she will follow safe sleep regulations specifally to include placing the infant into the crib once asleep to LPA Gaumann via email: jessica.gaumann@dss.ca.gov by 05/13/26
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Based on observation at 9:27am C1 was observed in a car seat. S1 interview stated C1 arrived sleeping in a car seat and was not moved until C1’s diaper was changed. At 11:38am infant C1 was observed sleeping on a cushion on the floor. Based on interview at 11:48am D1 stated she was planning to leave C1 sleeping on the floor, 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.
Melinda Mohr
NAME OF LICENSING PROGRAM MANAGER:
Jessica Gaumann
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/12/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/12/2026


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: FAIRFIELD PRESCHOOL & CHILDCARE
FACILITY NUMBER: 483010798
VISIT DATE: 05/12/2026
NARRATIVE
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A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Director (D1), Monika Verma.

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

LPA Jessica Gaumann informed facility representative that this report dated 05/12/2026 document(s) one Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk to the health, safety, or personal rights of children in care.



Also, LPA Jessica Gaumann informed the facility representative to provide a copy of this licensing report dated 05/12/2026 that documents any Type A citation(s) 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: Jessica Gaumann
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2026
LIC809 (FAS) - (06/04)
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