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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 490109271
Report Date: 01/10/2025
Date Signed: 01/10/2025 11:54:28 AM

Document Has Been Signed on 01/10/2025 11:54 AM - 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:4CS SONOMA CHILD DEVELOPEMENT CENTERFACILITY NUMBER:
490109271
ADMINISTRATOR/
DIRECTOR:		MARIA BURTONFACILITY TYPE:
850
ADDRESS:620 5TH STREETTELEPHONE:
(707) 996-3494
CITY:SONOMASTATE: CAZIP CODE:
95476
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 25DATE:
01/10/2025
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:14 AM
MET WITH:Martha DelgadoTIME VISIT/
INSPECTION COMPLETED:
12:05 PM
NARRATIVE
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Licensing Program Analyst (LPAs) Mindy Mohr and Jaelyn Agbayani made a case management inspection and met with Facility representative Martha Delgado. The inspection was made in response to water lead testing results received from the California State Water Resource Control Board.

The test results showed that the following samples tested above the allowable level 5.0 parts per billion (ppb) of lead in the water: Sample Site D had a reading of 5.7 ppb and sample site E had a reading of 17.000 ppb. All other sources of water tested below the allowable level of 5.0 ppb.

During today’s inspection, LPAs observed the water faucets originally used for drinking were removed completely and had permanent covers placed over the original faucet holes. Children in care are receiving drinking water from a filtered water dispenser. Children also bring individual water bottles from home and staff refill with the filter water as needed.


The following deficiency is being cited (see LIC 809D). A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Facility Representative, Martha Delgado.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melinda Mohr
LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2025
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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Document Has Been Signed on 01/10/2025 11:54 AM - It Cannot Be Edited


Created By: Melinda Mohr On 01/10/2025 at 11:24 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: 4CS SONOMA CHILD DEVELOPEMENT CENTER
FACILITY NUMBER: 490109271

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/10/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/13/2025
Section Cited
CCR
101238(a)

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Buildings and Grounds 101238(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. This requirement was not met as evidenced by:
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LPAs observed the facility has already removed the drinking faucets and placed permanent covers over the faucet holes.
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Based on record review, the facility had 2 faucets that exceeded that allowable levels of lead in the water. This is a potential health and safety risk to 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.
SUPERVISOR'S NAME:Leslie Lepori
LICENSING EVALUATOR NAME:Melinda Mohr
LICENSING EVALUATOR SIGNATURE:
DATE: 01/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/10/2025


LIC809 (FAS) - (06/04)
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