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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 283008069
Report Date: 06/15/2023
Date Signed: 06/15/2023 01:11:28 PM


Document Has Been Signed on 06/15/2023 01:11 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:NAPA VALLEY MONTESSORI LEARNING CENTER - P/SFACILITY NUMBER:
283008069
ADMINISTRATOR:SMITH, TERESITAFACILITY TYPE:
850
ADDRESS:120W AMERICAN CANYON ROAD M 11TELEPHONE:
(707) 853-9580
CITY:AMERICAN CANYONSTATE: CAZIP CODE:
94503
CAPACITY:37CENSUS: 22DATE:
06/15/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Kathryn LumbardTIME COMPLETED:
01:25 PM
NARRATIVE
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LPA Mohr was at the facility for a complaint investigation and observed 21 children on the playground. There is a waiver for the playground and the facility must follow these conditions as required :

There shall be at least 75 square feet per child of outdoor activity space based on the total license capacity. Licensee will not exceed 19 preschool children in the yard at one time.
A copy of the waiver shall be posted next to the License.


Based on LPA's observation of 21 children on the playground this is in violation of the
existing waiver that allows up to 19 children on the playground at any given time. This is a potential health and safety risk to children in care.

The following violation(s) of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Appeal Rights were provided.


The department will conduct further review of the waiver to determine the need for modification or termination as indicated in the waiver.

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 facility representative, Kathryn Lumbard

SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melinda MohrTELEPHONE: (707) 494-2125
LICENSING EVALUATOR SIGNATURE:
DATE: 06/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/15/2023
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 06/15/2023 01:11 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405


FACILITY NAME: NAPA VALLEY MONTESSORI LEARNING CENTER - P/S
FACILITY NUMBER: 283008069

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/15/2023
Section Cited
CCR
101238.2(a)

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There shall be at least 75 square feet per child of outdoor activity space based on the total licensed capacity.

This requirement is not met as evidence by:
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Director stated she will make a outdoor playyard schedule. This will make sure that no more than 19 children are on the playyard at any given time.
Director will email the outdoor playyard schedule to LPA at:
melinda.mohr@dss.ca.gov
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Based on LPA's observation of 21 children on the playground this is in viloation of the
existing waiver that allows up to 19 children on the playground at any given time. This is a potential health and safety risk to children 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: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melinda MohrTELEPHONE: (707) 494-2125
LICENSING EVALUATOR SIGNATURE:
DATE: 06/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/15/2023
LIC809 (FAS) - (06/04)
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