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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 485406990
Report Date: 02/10/2025
Date Signed: 02/10/2025 12:41:15 PM

Document Has Been Signed on 02/10/2025 12:41 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 RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:BELPERIO, JAMIE FCCHFACILITY NUMBER:
485406990
ADMINISTRATOR/
DIRECTOR:
BELPERIO, JAMIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 450-7441
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
02/10/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:36 AM
MET WITH:Jamie BelperioTIME VISIT/
INSPECTION COMPLETED:
12:55 PM
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An unannounced Case Management inspection was conducted at the facility by Licensing Program Analyst (LPA) M. Mohr in response to a self-reported Unusual Incident Report (UIR) received 01/17/2025 involving a child (C1) falling off the back deck and hitting their head on the cement. During today's visit, LPA met with Licensee Jamie Belperio (L1) to discuss the incident. L1 stated C1 was standing by the back door looking outside. When C1 was called for a diaper change C1 opened the screen door and ran out onto the deck, falling onto the cement. L1 also stated C1's guardian arrived to pick up C1 within minutes of the incident and decided not to take C1 to the doctor.

LPA observed the back deck has rails on all sides and 3 steps leading down to the cement. L1 stated when the children go outside they hold an adults hand down the three steps before entering into the gated outside play area. The children do not have access to the steps when playing outside. Furthermore, L1 stated she now keeps the sliding glass door all the way closed while children are in care, and has a child safety gate up keeping children out of the room where the sliding glass door is located.

There were no Title 22 violations cited during today's case management visit. The Notice of Site Visit shall be posted for 30 days.


Leslie LeporiTELEPHONE: (707) 588-5060
Melinda MohrTELEPHONE: (707) 494-2125
DATE: 02/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/10/2025
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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