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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483010806
Report Date: 06/02/2026
Date Signed: 06/02/2026 01:59:15 PM

Document Has Been Signed on 06/02/2026 01:59 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:LITTLE BLESSINGS DAYCARE & PRESCHOOLFACILITY NUMBER:
483010806
ADMINISTRATOR/
DIRECTOR:		MARTHA BARRON BOTELLOFACILITY TYPE:
860
ADDRESS:1679 SUNSET AVE.TELEPHONE:
(707) 720-9706
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 38TOTAL ENROLLED CHILDREN: 38CENSUS: 29DATE:
06/02/2026
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:03 PM
MET WITH:Martha Barron BotelloTIME VISIT/
INSPECTION COMPLETED:
12:49 PM
NARRATIVE
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An unannounced case management inspection was conducted today by Licensing Program Analyst (LPA) Yang. During the visit, the LPA met with the facility’s Licensee/Center Director, Martha Barron Botello, to discuss the facility’s compliance with lead testing requirements for licensed child care centers.

The purpose of today’s visit was to review and verify the facility’s compliance with Health and Safety Code (HSC) section 1597.16 and Assembly Bill (AB) 2370, which require licensed child care centers operating in buildings constructed before January 1, 2010, to test drinking water outlets for lead contamination. Pursuant to the written directives issued by the California Department of Social Services (CDSS), child care centers licensed on or after July 1, 2022, are required to complete lead testing within 180 days of licensure.

The facility was licensed on August 6, 2025. Based on the Department’s records, the facility was therefore required to complete lead testing and submit the required documentation within 180 days of licensure. Department records indicate that on October 2, 2025, the licensee contacted the Santa Rosa Regional Office to inquire about the lead testing requirements and compliance process. During that conversation, the licensee informed the Department that the facility’s drinking water had been tested for lead in March 2025, prior to licensure.

Although the licensee reported that testing had been completed, the Department has not received documentation verifying compliance with the lead testing requirements. Specifically, the Department has not received copies of the laboratory test results, sampling documentation, or the supplemental forms required to demonstrate that testing was conducted in accordance with CDSS written directives and applicable regulations. As a result, the Department is unable to verify whether all required water outlets were sampled, whether testing was conducted by an approved laboratory, or whether any corrective actions were required based on the results. (Continued on LIC809-C)

NAME OF LICENSING PROGRAM MANAGER: Melchisedeck Augustin
NAME OF LICENSING PROGRAM ANALYST: Yang Yang
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/02/2026
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: LITTLE BLESSINGS DAYCARE & PRESCHOOL
FACILITY NUMBER: 483010806
VISIT DATE: 06/02/2026
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The LPA discussed the lead testing requirements with the licensee and advised that documentation must be maintained on file and provided to the Department upon request. During today’s inspection visit, the licensee provided the LPA with copies of the following documents related to the facility’s lead testing:

1)Child Care Center Sampling Checklist (LIC 9276)

2)Copies of all laboratory lead testing results and any associated reports or documentation demonstrating completion of the testing requirements.

The following document(s) remain outstanding and shall be submitted to the local regional office:

1)External Water Sampler Self-Certification Form (LIC 9275)

2)Facility Sketch (LIC 999), clearly identifying the location of all water outlets within the facility, including outlets that were sampled and those that were not sampled.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the facility representative. There were no Title 22 deficiencies cited during today's inspection.

NAME OF LICENSING PROGRAM MANAGER: Melchisedeck Augustin
NAME OF LICENSING PROGRAM ANALYST: Yang Yang
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2026
LIC809 (FAS) - (06/04)
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