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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173000812
Report Date: 03/12/2025
Date Signed: 03/12/2025 11:52:46 AM

Document Has Been Signed on 03/12/2025 11:52 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 RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:LAKEPORT CHRISTIAN CENTER PRESCHOOLFACILITY NUMBER:
173000812
ADMINISTRATOR/
DIRECTOR:		PAARSCH, MARYFACILITY TYPE:
850
ADDRESS:175 C STREETTELEPHONE:
(707) 262-5520
CITY:LAKEPORTSTATE: CAZIP CODE:
95453
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: 9DATE:
03/12/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:31 AM
MET WITH:Michelle WalkerTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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An inspection was conducted at the facility by Licensing Program Analysts, Sebastian Phouthavong. LPA met with Site Supervisor, Michelle Walker. During the inspection the facility was toured inside and outside. 9 children were being supervised by 4 staff and operating within the licensed capacity and ratio requirements.

During the course of an investigation on 10/21/2024, LPA, Selena Mariani observed one child in one restroom, while another child was in another separate restroom. LPA observed one teacher walking from one bathroom doorway to other, not properly having visual observation of the children at all times. Additionally, S1 stated that children go to the restroom by themselves and that on Mondays and Fridays, fewer staff are present, so daycare children are not supervised when they are in the restroom. Also, children’s interview, C1 stated that teachers did not go into the facility restroom when children would go into the restroom. Also, C2 stated that staff are not present when using the bathroom. According to a parent interview, children were observed to go into the restroom to either change clothes or use the bathroom without teacher supervision. The facility has accessed the issue.

Additionally, the facility did not submit a written Unusual Incident Report (UIR) to the department and appropriate agencies with 7 days being notified. The incident occurred around 10/16/2024 regarding inappropriate actions by two children and involved a one staff member. In addition, Site Supervisor admitted that a written UIR was not submitted to the department.

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

Exit interview conducted and report was reviewed with the Site Supervisor, Michelle Walker.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE: DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/12/2025
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 03/12/2025 11:52 AM - It Cannot Be Edited


Created By: Sebastian Phouthavong On 03/12/2025 at 10:29 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: LAKEPORT CHRISTIAN CENTER PRESCHOOL
FACILITY NUMBER: 173000812

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/12/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/02/2025
Section Cited
CCR
101229(a)(1)

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101229(a)(1) Responsibility for Providing Care and Supervision:The licensee shall provide care and supervision...meet the children's needs....No child(ren) shall be left without the supervision of a teacher at any time...include visual observation. This requirement is not met as evidenced by:
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Site Supervisor stated she will submit an updated policy on supervision to ensure all children are being supervised at all times. The policy will be submitted to the department by 04/02/2025.
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Based on LPA's observation and interviews from one staff, two children and one parent, the facility were not properly supervising the children when in the restroom, which poses a potential health, safety or personal rights risk to persons in care.
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Type B
04/02/2025
Section Cited
CCR101212(d)(1)(D)

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101212(d)(1)(D)....a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event....Any suspected physical or psychological abuse of any child. This requirement is not met as evidenced by:
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Site Supervisor was provided the Regulation 101212 and will ensure to discuss the requirements with all staff. Site Supervisor stated she will submit proof of competition with all staffs’ signatures and dated when discussed. The document will be submitted to the department by 04/02/2025
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Based on review and staff interview, a written report was not submited to the department and appropriate agencies within 7 days, which poses a potential 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:Leslie Lepori
LICENSING EVALUATOR NAME:Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE:
DATE: 03/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/12/2025


LIC809 (FAS) - (06/04)
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