<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493005596
Report Date: 02/12/2025
Date Signed: 02/12/2025 02:39:24 PM

Document Has Been Signed on 02/12/2025 02:39 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:ROSEBUD PRESCHOOLFACILITY NUMBER:
493005596
ADMINISTRATOR/
DIRECTOR:		AMBER ASHWORTH-HIXFACILITY TYPE:
850
ADDRESS:2500 PATIO COURTTELEPHONE:
(707) 544-8600
CITY:SANTA ROSASTATE: CAZIP CODE:
95405
CAPACITY: 34TOTAL ENROLLED CHILDREN: 43CENSUS: 28DATE:
02/12/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Amber Ashworth-HixTIME VISIT/
INSPECTION COMPLETED:
02:40 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
An unannounced case management visit was made to the facility by Licensing Program Analyst (LPA) Amy Strother in response to a self-reported, lack of supervision incident involving child C1 and five staff, D1 and S1-S4, that occurred on 02/05/25. The Department received a phone call and an Unusual Incident Report (UIR) on 02/06/25. During today’s visit, LPA met with Center Director, Amber Ashworth-Hix (D1) to discuss the incident.

It was reported on the UIR, written by Site Supervisor Nicole Levesque (S4), that on 02/05/25, child C1 left the classroom, entering the playground area, which is fully fenced, without staff noticing, leaving C1 unsupervised for what was reported to be less than a minute during the transition to naptime. S4 reported that 5 staff were present and provided details as to what each staff was doing at the time of the reported incident. The report states that at the time of the incident D1 was helping a crying child, S1 was taking a child to the bathroom, S2 and S3 were helping children to their nap beds, and S4 was taking two children to the hallway for pickup time. S2 noticed that child C1 was not in the classroom and asked D1 if she knew where C1 was. D1 reported last seeing C1 by the shoe cubby by the back door. The report states that staff S3 helped to look for C1 and pulled back the blinds in the classroom, witnessing C1 standing outside by the door. LPA spoke with D1 and S1 – S4 during today’s visit, confirming that the incident report was an accurate account of what occurred on 02/05/25.

The self-reported incident was reported to CCLD as required per regulations. The Site Supervisor (S4) reported that this incident was also reported to the child’s (C1’s) authorized representative by way of a phone call. During today’s inspection D1 reported that the staff are now waiting to close the blinds until after the following procedures: last sweep of the outdoor yard, head count of children inside and making sure the door has fully latched, stating that the door swells in the weather and may not close thoroughly and would be easily pushed open by a child.

Continue on LIC809 - PAGE 2

SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE: 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)
Page: 1 of 3
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: ROSEBUD PRESCHOOL
FACILITY NUMBER: 493005596
VISIT DATE: 02/12/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
PAGE 2

During today’s case management visit, no children were observed to be left without supervision. LPA observed active supervision of children and teachers performing head counts and sweeps as stated, and always calling out the number of children they were taking from the group for bathroom visits etc. LPA also observed dry erase boards being used to write the current head count on.

Based on available information, it has been determined that D1 and staff S1-S4 did not provide adequate supervision to child C1 during the incident on 02/05/2025. The following violation of the California Code of Regulations, Title 22; Division 12, was observed: see LIC 809 Deficiency Page. Civil penalties are assessed on form LIC421FC for repeat violations within 12 months, in the amount of $250 for each repeat violation. This is a repeat violation, last cited on 09/19/24.

This report was read and reviewed with facility representative, Center Director, Amber Ashworth-Hix. Notice of site visit shall be posted for 30 days. Appeal were provided.

SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2025
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 02/12/2025 02:39 PM - It Cannot Be Edited


Created By: Amy Strother On 02/12/2025 at 02:02 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: ROSEBUD PRESCHOOL
FACILITY NUMBER: 493005596

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/12/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/26/2025
Section Cited
CCR
101229(a)(1)

1
2
3
4
5
6
7
Care and Supervision. No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.

This requirement was not met as evidenced by:
1
2
3
4
5
6
7
D1 stated that on 02/10/25, during a staff meeting staff discussed that they will do the following: wait to close the blinds until after the following procedures: last sweep of the outdoor yard, head count of children inside and making sure the door has fully latched and can not be pushed open.
8
9
10
11
12
13
14
Based on the Site Supervisor's written unusual incident report (UIR) submitted to CCLD on 02/06/25, stating that on 02/05/25 at approximately 12:55pm, child C1 left the classroom, entering the fully fenced playground without supervision of a teacher for less than one minute, before being brought back inside by staff S3, which posed a potential health and safety risk to a child in care.
8
9
10
11
12
13
14
D1 has also ordered a door alarm for the back door to be activated during indoor activity, including nap time. D1 will install the alarm and send a photo to LPA by 02/26/25. amy.strother@dss.ca.gov

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Megan Aviles
LICENSING EVALUATOR NAME:Amy Strother
LICENSING EVALUATOR SIGNATURE:
DATE: 02/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/12/2025


LIC809 (FAS) - (06/04)
Page: 3 of 3