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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 233010489
Report Date: 03/13/2024
Date Signed: 03/13/2024 01:52:52 PM

Document Has Been Signed on 03/13/2024 01:52 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:SHANEL VALLEY ACADEMY EARLY LEARNING CENTERFACILITY NUMBER:
233010489
ADMINISTRATOR:JACINTO, LINDAFACILITY TYPE:
850
ADDRESS:1 RALPH BETTCHER DRIVETELEPHONE:
(707) 744-1485
CITY:HOPLANDSTATE: CAZIP CODE:
95449
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 0DATE:
03/13/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:07 AM
MET WITH:Kristi McculloughTIME COMPLETED:
11:07 AM
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
An unannounced Case Management visit was made to the facility by Licensing Program Analyst (LPA) Robert Maciel to address an incident that was brought to attention of the Department by way of an unusual incident report dated 2/21/24. LPA met with Director, Kristi Mccullough (A1). The unusual incident report states that on 11/16/23 and 2/14/24, a child (C1) was restrained in the bathroom by staff. An independent investigation by the Shanel Valley Academy School Board into the incident was started on 12/18/23 and the report states that, although the school board was first notified of the incident on 12/14/23, they did not realize that they needed to report the incident to Community Care Licensing, treating the complaint as if it was a TK-6 student, not a preschool student.


The following deficiency is being cited (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 Director, Kristi Mccullough.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Robert Maciel
LICENSING EVALUATOR SIGNATURE: DATE: 03/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/13/2024
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 2
Document Has Been Signed on 03/13/2024 01:52 PM - It Cannot Be Edited


Created By: Robert Maciel On 03/13/2024 at 10:08 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: SHANEL VALLEY ACADEMY EARLY LEARNING CENTER
FACILITY NUMBER: 233010489

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/12/2024
Section Cited
CCR
101212(d)(1)(C)

1
2
3
4
5
6
7
101212 ...during the operation of the child care center if any of the events specified in (d)(1) below, a report shall be made to the Department by… next working day... In addition, a written report…shall be submitted to the Department within seven days...(1)Events reported shall include the following: (C)Any unusual incident or child absence that threatens the physical or emotional health or safety of any child.
This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Facility already submitted a unusual incident report regaridng the incident. LPA reviewed the reporting requirement regulations with the Director.
8
9
10
11
12
13
14
Based on interview and record review staff who directly observed or later became aware of the incidents did not report it to the Department and did not submit a written incident report as required. This poses a potential health, safety or personal rights risk to persons 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: 03/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/13/2024


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