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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 490104158
Report Date: 06/09/2026
Date Signed: 06/09/2026 06:10:15 PM

Document Has Been Signed on 06/09/2026 06:10 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:ADOBE CHRISTIAN PRESCHOOLFACILITY NUMBER:
490104158
ADMINISTRATOR/
DIRECTOR:		PFEIFER, ANDREAFACILITY TYPE:
850
ADDRESS:2875 ADOBE ROADTELEPHONE:
(707) 762-7713
CITY:PETALUMASTATE: CAZIP CODE:
94954
CAPACITY: 60TOTAL ENROLLED CHILDREN: 35CENSUS: 21DATE:
06/09/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:44 PM
MET WITH:Crystal MartinezTIME VISIT/
INSPECTION COMPLETED:
05:15 PM
NARRATIVE
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An annual required inspection was made to the facility by Licensing Program Analyst (LPA), Y. Yang. The facility file was reviewed prior to this inspection. A review of the personnel report on 06/09/26 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. The facility representative was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

The LPA met with the facility's center director, Crystal Martinez. The facility’s operating hours are 07:30am-05:00pm, Monday – Friday. The facility was toured inside and outside and the floor and yard plan submitted by the licensee were verified. The toys, floors, desks and other equipment and surfaces were clean, free of toxins, safe and in good condition. The facility was free of flies, insects and rodents. There is drinking water available to children both indoors in the classrooms and outdoors on the playground. The children’s bathrooms were in sanitary condition. Food prep areas are clean. Food is properly stored and free of contamination. Garbage cans containing solid waste were in good repair and had tight fitting lids. The facility's play yard is fully fenced and free of hazards. The play structure on the main play yard has wood chip cushioning material underneath. The facility representative stated no weapons are stored on site. The facility representative stated that poisons are stored on site. There is at least one smoke and carbon monoxide detector on site. During today's inspection the facility was operating within the licensed capacity. At least one staff member present during the visit possessed current CPR and First Aid certifications. The sign in/out procedure was reviewed and was in compliance with regulations. The facility uses an electronic sign in/out system. Eight children’s records were reviewed. The LPA observed that several children's files were missing documents such as physician's reports and immunization records. Five staff records were reviewed and contained the required documents as specified in the entrance checklist. Continued on LIC 809-C
NAME OF LICENSING PROGRAM MANAGER: Melchisedeck Augustin
NAME OF LICENSING PROGRAM ANALYST: Yang Yang
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 06:10 PM - It Cannot Be Edited


Created By: Yang Yang On 06/09/2026 at 03:35 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: ADOBE CHRISTIAN PRESCHOOL
FACILITY NUMBER: 490104158

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/09/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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 record review conducted by the LPA, the licensee did not comply with the section cited above in 5 out of 8 children's files reviewed. The LPA observed that Child C1,C2,C4,C7,and C8 did not have completed physician’s reports maintained in their files. This poses a potential health and safety risk to persons in care.
POC Due Date: 07/09/2026
Plan of Correction
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The director, Crystal Martinez, stated that she will immediately review all enrolled children’s files to ensure that a completed physician’s report is obtained and maintained for each child. The director will contact the parents or guardians of Child C1, C2, C4, C7, and C8 to obtain the missing physician’s reports.The director stated that all missing documentation will be obtained and placed in the respective children’s files, and that she will ensure ongoing compliance by reviewing each child’s file upon enrollment. Poof of correction will be submitted to the LPA by 07/09/26.
Type B
Section Cited
CCR
101220.1(g)
Immunizations
(g) The licensee shall document each child's immunizations and shall maintain such documentation in the center for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on a file review conducted by the LPA, the licensee did not comply with the section cited above in 2 out of 8 children's files reviewed. Specifically, the LPA observed that two children's files (C4 and C8) did not documentation of immunizations, which poses a potential health and safety risk to persons in care.

POC Due Date: 07/09/2026
Plan of Correction
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The director, Crystal Martinez stated that she will notify the parents or guardians of C4 and C8 regarding the missing immunization records and will review the files of all enrolled children to ensure that required documentation is complete and maintained at the facility. Martinez stated that proof of correction will be submitted to the LPA by 07/09/2026.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Melchisedeck Augustin
NAME OF LICENSING PROGRAM MANAGER:
Yang Yang
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 06:10 PM - It Cannot Be Edited


Created By: Yang Yang On 06/09/2026 at 03:35 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: ADOBE CHRISTIAN PRESCHOOL
FACILITY NUMBER: 490104158

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/09/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101226(e)(3)(A)
Health-Related Services
(3) Prescription medications may be administered if all of the following conditions are met: (A) Prescription medications shall be administered in accordance with the label directions as prescribed by the child's physician.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review conducted by the LPA, the licensee did not comply with the section cited above. The LPA observed that Child C1 had an EpiPen on site; however, the EpiPen was not in its original packaging and did not include the required accompanying documentation. This poses a potential health and safety risk to persons in care.
POC Due Date: 07/09/2026
Plan of Correction
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The director stated that she will immediately ensure that all medications, including EpiPens, are maintained in their original packaging and include all required physician instructions and documentation as required. The director will contact the child’s parent/guardian to obtain a properly packaged EpiPen with accompanying physician’s orders and any required documentation.

The director will review all enrolled children’s medication records and supplies to ensure compliance with regulatory requirements and will correct any additional deficiencies identified. The director stated that she will implement an ongoing procedure to verify that all medications brought into the facility are properly labeled, stored in original packaging, and accompanied by current physician instructions at the time of receipt. Proof of correction will be submitted to the LPA by 07/09/26.
Type B
Section Cited
CCR
101227(a)(16)
Food Service
(16) Pesticides and other similar toxic substances shall not be stored in food storerooms, kitchen areas, food-preparation areas, or areas where kitchen equipment or utensils are stored.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation conducted by the LPA, the licensee did not comply with the section cited above.The LPA observed a can of Terro spider killer located in the kitchen area, which is an area that is off limits to children in care. The director was notified that pesticides and poisons are not to be stored in food preparation areas at any time, even if no daycare children are present in the area. This poses a potential health and safety risk to persons in care
POC Due Date: 06/10/2026
Plan of Correction
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The director immediately removed the can of spider killer from the kitchen area and stated that it will be stored in a locked cabinet inaccessible to children in care and away from food prep and storage areas. The director will ensure that all pesticides and toxic substances are stored in accordance with licensing requirements at all times.Additionally, the director stated that she will notify and speak with church staff members, as the preschool is located within a church facility, to ensure they are aware that pesticides and other toxic substances shall not be stored in food preparation or kitchen areas at any time.The director stated that she will conduct ongoing checks of the facility to ensure continued compliance with storage requirements.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Melchisedeck Augustin
NAME OF LICENSING PROGRAM MANAGER:
Yang Yang
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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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: ADOBE CHRISTIAN PRESCHOOL
FACILITY NUMBER: 490104158
VISIT DATE: 06/09/2026
NARRATIVE
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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. 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/.

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). During today's visit, the LPA was unable to verify that lead testing was done in accordance to the Written Directives outlined in PIN 21-21.1-CCP. The facility representative was unable to provide the LPA with the required documents.

The facility representative 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 (R&Rs) throughout California.

California Code of Regulations, Title 22, is being cited on the attached LIC 809-D. An exit interview was conducted, and this report was read and discussed with the center director, Crystal Martinez. A notice of site visit was given and must remain posted for 30 days. Appeal rights provided.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process
NAME OF LICENSING PROGRAM MANAGER: Melchisedeck Augustin
NAME OF LICENSING PROGRAM ANALYST: Yang Yang
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
LIC809 (FAS) - (06/04)
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