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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010604
Report Date: 07/30/2024
Date Signed: 07/31/2024 08:58:47 AM

Document Has Been Signed on 07/31/2024 08:58 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 CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:ST. JOHN THE BAPTIST CATHOLIC SCHOOLFACILITY NUMBER:
493010604
ADMINISTRATOR/
DIRECTOR:		LOPEZ, JENNIFERFACILITY TYPE:
860
ADDRESS:217 FITCH STREETTELEPHONE:
(707) 433-2758
CITY:HEALDSBURGSTATE: CAZIP CODE:
95448
CAPACITY: 18TOTAL ENROLLED CHILDREN: 18CENSUS: 0DATE:
07/30/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Megan Ferguson & Jenny LoppezTIME VISIT/
INSPECTION COMPLETED:
12:00 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
A prelicensing inspection was conducted today by Licensing Program Analyst (LPA), J. Snow. LPA met with facility representative Megan Ferguson, Jenny Lopez. The applicant/licensee is requesting a license for 18 preschool children from age 2-5 years old in room #1. The facility will operate Monday - Friday, 7:30am to 4pm. The facility has 1 classroom, 2 bathrooms. The preschool building also contains the Kindergarteners in a second room and is located on St. John the Baptist Catholic School grounds, (age 4 through 14). The indoor and outdoor activity spaces were toured, and the facility sketch was verified. The no areas will be off limits to children. There is a kitchen in a different building that is inaccessible. Parents bring meals and snack from home; facility provides the afternoon snack. The poisons are locked in the janitors’ closet located in another building.

Preschool children will be cared for in room # 1 which measure 755 square feet square feet which is enough for the requested capacity. Description. There are 2 bathrooms, one (toilet) is in the kindergarten next door and 2 other (2 toilets) are located across the courtyard as part of the school. Children will be escorted to both bathrooms (waiver). Children will nap on mats. The isolation area for sick children will be located is an office. There is safe and age-appropriate furniture, toys, and play equipment available for children.
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Jaime Snow
LICENSING EVALUATOR SIGNATURE: DATE: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/30/2024
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: ST. JOHN THE BAPTIST CATHOLIC SCHOOL
FACILITY NUMBER: 493010604
VISIT DATE: 07/30/2024
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
The outdoor play area will be shared with the school & children will not be commingled (waiver) & measures 3227 square feet which is enough for the requested capacity. It’s fully fenced & there is a climbing dome age 3-5 and the staff will monitor to ensure proper use. There is also a slide, tunnel and monkey bars all rated age 2-5. All large climbing equipment is anchored into the ground with adequate cushioning underneath. There is no pool, spa, pond, fountain, or any other body of water on the premises. Based on the above, the maximum capacity of the facility could be 30. Facility representative was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

LPA reviewed with facility representative the LIC 311A, Records to Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted. LPA discussed the safe sleep regulations with the facility representative and discussed the Child Care Licensing Safe Sleep webpage at:
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Jaime Snow
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024
LIC809 (FAS) - (06/04)
Page: 2 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: ST. JOHN THE BAPTIST CATHOLIC SCHOOL
FACILITY NUMBER: 493010604
VISIT DATE: 07/30/2024
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
https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep, as an additional resource. LPA also informed the facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: https://www.cpsc.gov/, and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

The facility Representative was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Exit interview conducted and report was reviewed with the facility representative. Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.


The following items need to be completed prior to the granting the license:

1. Waiver approval for the shared yard
2. Waiver approval for the shared bathroom
3. Managerial approval which may require updates
4. Additional documents may be requested.
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Jaime Snow
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024
LIC809 (FAS) - (06/04)
Page: 3 of 3