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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 490111750
Report Date: 08/10/2023
Date Signed: 08/10/2023 12:18:09 PM

Document Has Been Signed on 08/10/2023 12:18 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: 110TOTAL ENROLLED CHILDREN: 110CENSUS: DATE:
08/10/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:33 AM
MET WITH:Nancy YoungTIME COMPLETED:
12:28 PM
NARRATIVE
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During the course of opening an investigation, Licensing Program Analyst (LPA) Robert Maciel arrived at the facility at 8:35 AM and observed 19 children being supervised by one staff member, staff 1 (S1), in a classroom and 26 children being supervised by one staff, staff 2 (S2), in a separate classroom. LPA Maciel spoke with director Nancy Young about being out of ratio to which she stated that the total number of staff compared to the total number of children followed the ratio requirements thus she believed the facility was in compliance. Director was not observed providing care and supervision to children in the two classrooms.

The following violations of the California Code of Regulations, Title 22; Division 12 were observed during today's inspection. See LIC 809-D for deficiency cited during today's inspection.

Reports citing Type A violations are to be provided to parents/guardians of children currently enrolled and to parents/guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must sign Form LIC 9224 to be kept in each child's file.

This report was reviewed and discussed with Director, Nancy Young. Appeal Rights were provided.

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.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Robert Maciel
LICENSING EVALUATOR SIGNATURE: DATE: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/10/2023
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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Document Has Been Signed on 08/10/2023 12:18 PM - It Cannot Be Edited


Created By: Robert Maciel On 08/10/2023 at 11:15 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: REDWOOD COUNTRY KIDS CLUB
FACILITY NUMBER: 490111750

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/11/2023
Section Cited
CCR
101516.5(b)(1)

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A teacher shall supervise no more than 14 children or with an aide a maximum of 28 children.
This requirement was not met as evidenced by:
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Director stated she will staff one more teacher between 8:30-9:00 AM to satisfy ratio requirements.
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Based on LPA observations, one staff member was supervising 19 children in a room and one staff member was supervising 26 children in another room 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.
SUPERVISOR'S NAME:Alexis Hollon
LICENSING EVALUATOR NAME:Robert Maciel
LICENSING EVALUATOR SIGNATURE:
DATE: 08/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/10/2023


LIC809 (FAS) - (06/04)
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