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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 233007690
Report Date: 08/15/2023
Date Signed: 08/15/2023 01:46:56 PM

Document Has Been Signed on 08/15/2023 01:46 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:MORRIS, LAUREN FCCHFACILITY NUMBER:
233007690
ADMINISTRATOR:MORRIS , LAURENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 456-9880
CITY:WILLITSSTATE: CAZIP CODE:
95490
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
08/15/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Lauren MorrisTIME COMPLETED:
02:55 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 Case Management visit was conducted at the facility by Licensing Program Analyst (LPA) Robert Maciel in response to an Unusual Incident Report received August 3, 2023 involving a lack of supervision. LPA met with Licensee Lauren Morris (S1). According to the incident report and interviews conducted, at 12:06 PM on July 28, 2023, child 1 (C1) had run out of the house and was discovered by adult 2 (A2) a few houses down the street sitting with adult 4 (A4) at approximately 12:30 PM. S1 came to pick up C1 and called parent 1 (P1) who arrived soon after. Police arrived at the place where C1 was found and spoke to P1. C1 returned to the facility at approximately 12:50 PM. C1 was outside for at least 20 minutes unsupervised. During today's visit, there were 6 children accounted for being supervised by 2 staff. Based on available information, it has been determined that day care staff were not properly supervising the children when the incident occurred on July 28th, 2023.

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

Notice of site visit must be posted for 30 days. Reports citing Type A violations are to be provided to parents/guardians of children currently enrolled and to parents/guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must sign Form LIC 9224 to be kept in each child's file. Appeal rights were provided during visit.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Robert Maciel
LICENSING EVALUATOR SIGNATURE: DATE: 08/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2023
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 2
Document Has Been Signed on 08/15/2023 01:46 PM - It Cannot Be Edited


Created By: Robert Maciel On 08/15/2023 at 12:48 PM
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: MORRIS, LAUREN FCCH
FACILITY NUMBER: 233007690

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/16/2023
Section Cited
CCR
102417(a)

1
2
3
4
5
6
7
The licensee shall be present in the home and shall ensure that children in care are supervised at all times...
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee stated that the gate latch for the facilities exit was broken at the time of the incident and was fixed as of 7/31/23. LPA observed the gate latch was fixed.
8
9
10
11
12
13
14
Based on an unusual incident report and licensee statement, a child eloped from the facility while unsupervised which poses an immediate health & safety risk to children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Alexis Hollon
LICENSING EVALUATOR NAME:Robert Maciel
LICENSING EVALUATOR SIGNATURE:
DATE: 08/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/15/2023


LIC809 (FAS) - (06/04)
Page: 2 of 2