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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483010481
Report Date: 04/14/2026
Date Signed: 04/14/2026 12:32:32 PM

Document Has Been Signed on 04/14/2026 12:32 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:BAYNORTH LEARNING CENTER - PRESCHOOLFACILITY NUMBER:
483010481
ADMINISTRATOR/
DIRECTOR:		TANIKA HOPKINSFACILITY TYPE:
850
ADDRESS:2100 PENNSYLVANIA AVENUETELEPHONE:
(707) 720-5278
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 53TOTAL ENROLLED CHILDREN: 53CENSUS: 17DATE:
04/14/2026
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:56 AM
MET WITH:Lysandrea JacksonTIME VISIT/
INSPECTION COMPLETED:
09:57 AM
NARRATIVE
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During the course of a complaint investigation, additional information was received. Licensing Program Analyst (LPA) Jessica Gaumann met with Director (D1) Lysandrea Jackson to discuss the incidents.

During an interview conducted with D1 today, 04/14/26, D1 reported that 9 children had Hand, Foot and Mouth Disease with the first case noted on 04/07/26. Although D1 reported the incident via in-person interview with LPA, the incident was not reported to the Department by telephone or fax within the Department’s next working day and during business hours as required. The facility violated California Code of Regulations (CCR) 101212(d)(1)(E) which requires the facility to notify the Department of any epidemic outbreak of two or more children of any communicable disease.

Upon arrival to the facility LPA observed S2 supervising children in the preschool. A review of the LIC 500 Personnel Report on 04/14/26 indicates S2 has worked at the facility since 08/27/24. LPA was able to verify that S2 has received criminal record and child abuse index clearances or exemptions but is not associated to this facility. The facility representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

The facility violated California Code of Regulations (CCR) 101170(e)(2) which requires all individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility request a transfer of a criminal record clearance.

Continued on LIC 809C

NAME OF LICENSING PROGRAM MANAGER: Melinda Mohr
NAME OF LICENSING PROGRAM ANALYST: Jessica Gaumann
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/14/2026
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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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: BAYNORTH LEARNING CENTER - PRESCHOOL
FACILITY NUMBER: 483010481
VISIT DATE: 04/14/2026
NARRATIVE
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The following violation of the California Code of Regulations, Title 22; Division 12, was observed: see LIC 809D. A $500 Civil Penalty has been accessed. 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, Lysandrea Jackson.

NAME OF LICENSING PROGRAM MANAGER: Melinda Mohr
NAME OF LICENSING PROGRAM ANALYST: Jessica Gaumann
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/14/2026 12:32 PM - It Cannot Be Edited


Created By: Jessica Gaumann On 04/14/2026 at 11:22 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: BAYNORTH LEARNING CENTER - PRESCHOOL
FACILITY NUMBER: 483010481

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/14/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/28/2026
Section Cited
CCR
101212(d)(1)(E)

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101212(d)(1)(E) Upon the occurrence, during the operation of the child care cente...a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours…(1) Events reported shall include the following: (E) Epidemic outbreaks.

This requirement was not met as evidenced by:
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D1 will submit form LIC624 outlining the details of the unusual incident to the Department. D1 will review Title 22 Reporting Requirements provided by LPA and submit a statement that she has reviewed the regulation and understands the requirements to LPA Gaumann via email: jessica.gaumann@dss.ca.gov
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Based on D1 admitting to not reporting the outbreak that began on 04/07/26 and the Department has no record of the incident reported to the Department within the Department’s next working day during normal business hours. This poses a potential health, safety or personal rights risk to persons in care.
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Type B
04/28/2026
Section Cited
CCR101170(e)(2)

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101170(e)(2) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:(2) Request a transfer of a criminal record clearance as specified in Section 101170(f)

This requirement is not met as evidenced by:
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D1 stated she will submit LIC 9182 and stated that she will create a written procedure for associating employee fingerprint clearances to the facility, including how to verify that it has been completed, sending the written procedure to LPA Gaumann via email: jessica.gaumann@dss.ca.gov
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Based on observation, record review, and interview D1 did not associate 1 of 2 staff present today criminal record clearances to the facility. S2’s criminal record clearances was not transferred to the facility prior to the first day of employment, which poses a potential health and safety 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.
Melinda Mohr
NAME OF LICENSING PROGRAM MANAGER:
Jessica Gaumann
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/14/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/14/2026


LIC809 (FAS) - (06/04)
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