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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483010798
Report Date: 11/05/2025
Date Signed: 11/13/2025 02:17:37 PM

Document Has Been Signed on 11/13/2025 02:17 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:FAIRFIELD PRESCHOOL & CHILDCAREFACILITY NUMBER:
483010798
ADMINISTRATOR/
DIRECTOR:		OLDANI, SABRINAFACILITY TYPE:
860
ADDRESS:1004 UTAH STREETTELEPHONE:
(901) 240-7791
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 44TOTAL ENROLLED CHILDREN: 9CENSUS: 6DATE:
11/05/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:56 PM
MET WITH:Monika VermaTIME VISIT/
INSPECTION COMPLETED:
07:01 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Amy Strother and Jessica Gaumann arrived to the facility for the purpose of conducting multiple complaint investigations. When LPAs arrived they were greeted by staff (S1) at the office slider door. LPAs entered the infant room observing 6 children present, 2 in the play room and 4 in the nap room, with one staff, S1. S1 stated that the Licensee just left to go across the street to her other center. S1 called L1 back to the center. S1 and L1 stated that 3 of the children in care (C1-C3) are infants and the other 3 children (C4-C6) were preschool age. L1 stated that she is having a staffing shortage and needed to combine the ages today. Although the facility has a waiver on file to commingle infant and preschool aged children, it is to be only between 7:30am-8:00am and 5:00pm-5:30pm or for up to one hour 4:30-5:30pm, with staff-infant ratio of 1:4 infants and teacher-child ratios of 1:12.

During a tour of the facility, LPAs observed multiple "rat & mouse killer" black boxes on the preschool yard. The boxes had labels that stated "do not allow children or pets to play with the bait station, if swallowed, call a poison control center, doctor or..." Based on interviews conducted, children have been observed playing on the play yard while the poison bait boxes were present in the play area.

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 to licensee and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Continue on LIC809-C

NAME OF LICENSING PROGRAM MANAGER: Melchisedeck Augustin
NAME OF LICENSING PROGRAM ANALYST: Amy Strother
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/05/2025
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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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: FAIRFIELD PRESCHOOL & CHILDCARE
FACILITY NUMBER: 483010798
VISIT DATE: 11/05/2025
NARRATIVE
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Exit interview conducted and report was reviewed with licensee, Monika Verma.

LPA Strother informed licensee Monika Verma that this report dated 11/05/25 documents one Type A citation. Type A citations shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Strother informed the licensee to provide a copy of this licensing report dated 11/05/25 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

NAME OF LICENSING PROGRAM MANAGER: Melchisedeck Augustin
NAME OF LICENSING PROGRAM ANALYST: Amy Strother
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025
LIC809 (FAS) - (06/04)
Page: 5 of 5
Document Has Been Signed on 11/05/2025 07:01 PM - It Cannot Be Edited


Created By: Amy Strother On 11/05/2025 at 05:17 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: FAIRFIELD PRESCHOOL & CHILDCARE
FACILITY NUMBER: 483010798

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/05/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
11/06/2025
Section Cited
CCR
101238(g)(1)

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(g) Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children. (1)Storage areas for poisons shall be locked.

This requirement was not not been met as evidenced by:
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L1 stated that she will remove the traps from the playground and take them home. L1 will send LPA a video of the preschool yard tomorrow to cell phone (707)599-1479 and a signed written statement that L1 understands that any poisons on the premises must be under key or combination lock during child care hours to LPA's email: amy.strother@dss.ca.gov
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Based on observation and interview, multiple rodent poison bait traps were observed on the preschool playground. Based on interview the traps were present when the playground was used by children on 11/04/25, which poses an immediate health and safety risk to children 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.
Melchisedeck Augustin
NAME OF LICENSING PROGRAM MANAGER:
Amy Strother
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 11/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/05/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/05/2025 07:01 PM - It Cannot Be Edited


Created By: Amy Strother On 11/05/2025 at 05:30 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: FAIRFIELD PRESCHOOL & CHILDCARE
FACILITY NUMBER: 483010798

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/05/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/06/2025
Section Cited
CCR
101438.3(b)

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(b) Indoor activity space for infants shall be physically separate from space used by children in the child care center and school-age child care center components.

This requirement was not not been met as evidenced by:
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L1 stated that she will close the preschool classroom and use the staff she has to keep infant room open, until she hires more staff. L1 stated she will message families on the ProCare app. L1 will send a photo of the message sent to the 3 preschool families and a statement that L1 understands when commingling is allowed by tomorrow 11/06/25. amy.strothher@dss.ca.gov
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Based on observation, LPAs entered the infant room observing 6 children present, 2 in the play room and 4 in the nap room, with one staff, S1, which poses a potential health & safety or personal rights risk to persons in care.
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Type B
11/06/2025
Section Cited
CCR101216.3(a)(1)

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(a) There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance, except as specified in (b) and (c) below.(1) The number of children in attendance shall not exceed licensed capacity.

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L1 stated that she will close the preschool classroom and use the staff she has to keep infant room open, until she hires more staff. L1 stated she will message families on the ProCare app. L1 will send a photo of the message sent to the 3 preschool families and a statement that L1 understands the ratio and capacity of each classroom by tomorrow 11/06/25. amy.strothher@dss.ca.gov
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Based on observation, LPAs entered the infant room observing 6 children present, 2 in the play room and 4 in the nap room, with one staff, S1, 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.
Melchisedeck Augustin
NAME OF LICENSING PROGRAM MANAGER:
Amy Strother
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 11/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/05/2025


LIC809 (FAS) - (06/04)
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