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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 230111196
Report Date: 01/09/2026
Date Signed: 01/09/2026 01:30:37 PM

Document Has Been Signed on 01/09/2026 01:30 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:NCO HEAD START - WILLITS CENTERFACILITY NUMBER:
230111196
ADMINISTRATOR/
DIRECTOR:		FISCHBACH, TANISHAFACILITY TYPE:
850
ADDRESS:20 SPRUCE STREETTELEPHONE:
(707) 459-5141
CITY:WILLITSSTATE: CAZIP CODE:
95490
CAPACITY: 40TOTAL ENROLLED CHILDREN: 16CENSUS: 12DATE:
01/09/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:41 AM
MET WITH:Kara HessTIME VISIT/
INSPECTION COMPLETED:
01:37 PM
NARRATIVE
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A case management visit was made to the facility today by Licensing Program Analyst (LPA) Robert Maciel for the purpose of continuing the investigation of two separate unusual incident reports submitted to the department on 11/17/25, regarding a child (C1), who was allegedly pinched by a staff member on the arm, and on 12/8/25 regarding C1, who was left outside on the playground during transition into the classroom. LPA met with Facility Representative Kara Hess (D2).

During today's visit, LPA interviewed staff (S2-S4). On 12/19/25, LPA reviewed camera footage which showed that on 12/8/25, C1 was outside by themselves from 11:20 AM to 11:21 AM after staff (S2-S4) moved the other children inside the classroom with C1 sitting on a bench next to the staff and children lining up to go inside. The bench that C1 was sitting on was approximately 5 to 10 feet away from the staff and children which appeared to be within eyesight of S2-S4. During interviews, S2-4 stated that they did not intentionally leave C1 outside during transition. LPA observed that the playground that C1 was in is fully fenced and C1 was not in danger of leaving the facility ground as there are 3 gates in between the enclosed playground they were in and the exterior of the facility.

Facility Representative Kara Hess stated that in response to this incident, staff have been placed on corrective action plans to be followed up with active supervision training which includes head count procedure during transition and that staff have already received active supervision training from Education Management.

Continued on LIC809-C
NAME OF LICENSING PROGRAM MANAGER: Melchisedeck Augustin
NAME OF LICENSING PROGRAM ANALYST: Robert Maciel
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 01/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2026
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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Document Has Been Signed on 01/09/2026 01:30 PM - It Cannot Be Edited


Created By: Robert Maciel On 01/09/2026 at 11:43 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: NCO HEAD START - WILLITS CENTER
FACILITY NUMBER: 230111196

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/09/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/23/2026
Section Cited
CCR
101229(a)(1)

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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 is not met as evidenced by:
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Facility Representative stated staff will receive training on the Supervision of Children, will review the Standards of Conduct, the Child Safety Policy, and the General Guidelines for Supervision of Children,
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Based on an unusual incident report, staff statement, and camera footage, a child (C1) was left outside on a bench for about 1 minute which poses a potential health & safety risk to children in care.
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and a Performance Improvement Plan will be developed for the staff involved in the incident. Proof of completion of the training and plan will be sent to LPA by email at robert.maciel@dss.ca.gov by 1/23/26.

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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.
Melchisedeck Augustin
NAME OF LICENSING PROGRAM MANAGER:
Robert Maciel
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 01/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2026


LIC809 (FAS) - (06/04)
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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: NCO HEAD START - WILLITS CENTER
FACILITY NUMBER: 230111196
VISIT DATE: 01/09/2026
NARRATIVE
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Continued from LIC809

On 11/24/25, LPA interviewed staff (D2, S2, and S3) and attempted to interview two children, including C1, which did not provide any evidence to corroborate the claim that C1 was pinched by a staff member. During interviews with staff, S2-S3 stated that they were not aware of C1 being pinched, D2 stated that administrative staff from Head Start (D3 and D4) made an internal investigation after the incident was brought to their attention which did not provide any corroborating evidence of the allegation. Statements provided by facility staff did not provide evidence to corroborate the claims that staff pinched a child.

It has been determined that there is insufficient evidence to corroborate allegation that staff pinched a child however there is sufficient evidence to prove that C1 was left unattended in the playground without supervision for approximately one minute.
The following violation of the California Code of Regulations, Title 22; Division 12, was observed: see LIC 809D. Appeal rights were provided. Report was reviewed and Facility Representative Kara Hess. A notice of site visit was given and must remain posted for 30 days. Failure to do so shall result in an immediate civil penalty of $100.
NAME OF LICENSING PROGRAM MANAGER: Melchisedeck Augustin
NAME OF LICENSING PROGRAM ANALYST: Robert Maciel
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2026
LIC809 (FAS) - (06/04)
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