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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 490111750
Report Date: 09/01/2023
Date Signed: 09/01/2023 02:27:31 PM


Document Has Been Signed on 09/01/2023 02:27 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:REDWOOD COUNTRY KIDS CLUBFACILITY NUMBER:
490111750
ADMINISTRATOR:YOUNG, NANCYFACILITY TYPE:
840
ADDRESS:1340 MEDICAL CENTERTELEPHONE:
(707) 586-0675
CITY:ROHNERT PARKSTATE: CAZIP CODE:
94928
CAPACITY:110CENSUS: DATE:
09/01/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:16 PM
MET WITH:Nancy YoungTIME COMPLETED:
03:06 PM
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Licensing Program Analyst (LPA), Robert Maciel conducted a Plan of Correction (POC) visit and met with the Director, Nancy Young, for the purpose of following up on a type A deficiency that was cited. On 08/10/23, the facility was cited for operating out of ratio, when LPA observed one staff (S1) alone was providing care and supervision for 19 children and another staff (S2) alone providing care for 26 children. Upon LPA's arrival at 2:16pm, there were 0 children in care and 6 staff in the facility. LPA was shown a list of expected attendance for the afternoon which revealed a maximum possible attendance of 64 children for the afternoon. Based on LPA's observations, the facility is complying with the staffing ratio requirements. LPA cleared the deficiency, provided a POC clearance letter; consulted on and provided the facility representative with California of Regulations (CCR) 102416.5.

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 Director, Nancy Young. There were no violation(s) of the California Code of Regulations, Title 22 issued during this visit.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Robert MacielTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:
DATE: 09/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/01/2023
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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