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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493009877
Report Date: 06/09/2026
Date Signed: 06/09/2026 04:52:30 PM

Document Has Been Signed on 06/09/2026 04:52 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:FULTON COMMUNITY SCHOOL & FARMFACILITY NUMBER:
493009877
ADMINISTRATOR/
DIRECTOR:		RENEE WHITLOCK-HEMSOUVANHFACILITY TYPE:
850
ADDRESS:1225 FULTON ROADTELEPHONE:
(707) 523-8035
CITY:SANTA ROSASTATE: CAZIP CODE:
95401
CAPACITY: 75TOTAL ENROLLED CHILDREN: 81CENSUS: 27DATE:
06/09/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:10 PM
MET WITH:Renee Whitlock-HemsouvanhTIME VISIT/
INSPECTION COMPLETED:
05:07 PM
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A Case Management inspection was conducted at the facility by Licensing Program Analyst (LPA) Amy Strother in response to an Unusual Incident Report (UIR) filed by the Center Director, Renee Whitlock-Hemsouvanh (D1). The UIR was received by the Department on 5/13/26. The incident was regarding two children C1 and C2 engaging in inappropriate contact with one other. D1 reported that the week of 04/27/26 staff (S1) observed children C1 and C2 engaging in inappropriate contact, intervened and corrected the behavior. On 05/07/26 a parent reported to the facility that their child reported that they were touched by another child, stating that the child did not tell the teacher.

It is unclear if the incident reported by the parent on 05/07/26 was the same as the incident S1 observed during the week of 04/27/26 or an additional incident. D1 reports in the UIR that in response to the incident, active supervision was reviewed with staff, staff were interviewed by D1 and all areas of the play yard were walked to identify any potential visual barriers. D1 reports that all staff were given an active supervision video to review and 3 handouts to read. Additionally, D1 stated in the UIR that all landscaping was inspected and trimmed to ensure visibility. The parents of C1 and C2 were made aware of the incident, keeping the names of children involved confidential. Prior to the incident, on 03/24/26 D1 sent out a letter to all families about appropriate and inappropriate body exploration in the school environment, based on hearing children start to verbalize natural curiosities, requesting that families discuss appropriate boundaries at school.

D1 states in the report that S1 believed that the observed incident between C1 and C2 was within the scope of developmentally appropriate behavior, although not school appropriate. D1 attachment to the UIR staff declaration that they received training on active supervision on 05/11/26.

Continue on LIC809C

NAME OF LICENSING PROGRAM MANAGER: Melchisedeck Augustin
NAME OF LICENSING PROGRAM ANALYST: Amy Strother
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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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: FULTON COMMUNITY SCHOOL & FARM
FACILITY NUMBER: 493009877
VISIT DATE: 06/09/2026
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During today’s inspection, LPA met with Center Director, Renee Whitlock-Hemsouvanh (D1). LPA toured the facility, obtained facility documents, and conducted interviews with D1 and three staff (S2-S4). Staff demonstrated understanding of active supervision and awareness of their responsibilities to supervise children at all times. Each staff gave a detailed account of how children’s names are written on a white board as they enter the space and the total number of children counted and written on the board, tracking numbers as children leave or enter the space. Staff gave examples of how supervision needs are met, moving away from a zone that is not being used by children to assist in the more occupied areas. The staff interviewed were consistent with one another in naming the zones of supervision within the large outdoor play areas, and with D1’s explanation of the zones of supervision during LPA’s tour of the play areas.

D1 and S2-S4 all spoke of increased supervision that is provided for children that have been identified as needing “shadowing” by staff due to behavior or developmental needs. Staff stated that they can send messages to the whole staff team via text message if needed, but mostly rely on communication verbally, calling out to the staff in the area the child is moving to, making sure they are aware to move in a little closer to the child with increased supervision needs. For example, “Child’s name is moving to the slide area.” During the interview with D1, D1 identified both C1 and C2 as two of the children that were receiving increased supervision. D1 stated that the increased supervision for C1 and C2 began months prior to the reported incident, and for reasons unrelated to the incident.

During today’s visit, a total of 27 children were supervised by 6 staff. LPA observed appropriate supervision practices by staff while making observations.

There were no Title 22 deficiencies cited during today's inspection.

A notice of site visit was given to licensee and must remain posted for 30 days.

Exit interview conducted and report was reviewed with facility representative, Renee Whitlock-Hemsouvanh.

NAME OF LICENSING PROGRAM MANAGER: Melchisedeck Augustin
NAME OF LICENSING PROGRAM ANALYST: Amy Strother
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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