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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 485407185
Report Date: 05/29/2025
Date Signed: 05/29/2025 05:42:21 PM

Document Has Been Signed on 05/29/2025 05:42 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:LITTLE FLOWERS MONTESSORIFACILITY NUMBER:
485407185
ADMINISTRATOR/
DIRECTOR:		SMITH, JACLYNFACILITY TYPE:
850
ADDRESS:3561 ALAMO DRIVETELEPHONE:
(707) 474-8715
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY: 120TOTAL ENROLLED CHILDREN: 67CENSUS: 42DATE:
05/29/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:28 PM
MET WITH:Center Director JaclynTIME VISIT/
INSPECTION COMPLETED:
05:50 PM
NARRATIVE
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Licensing Program Analyst (LPA) Elpidia Hernandez Torres arrived to the facility to conduct a case management visit regarding a self reported incident that occurred on 04/30/2025. A guardian exited the classroom into an enclosed side yard which leads to the preschool play yard and a child (C1) followed, but stayed in the side yard not making it to the play yard when a staff (S1) got the child by the hand and walked them back into the classroom.

Interviews revealed, S1 entered the classroom and saw a shadow through the window which prompted S1 to go outside and observe what the shadow was, S1 saw C1 walking behind guardian who had entered the preschool play yard. S1 got C1s hand and walked them back into the classroom. In the classroom C1's guardian was speaking with Assistant center director. S1 reported C1 couldn't have been outside for more than 5 minutes. Assistant center director reported another staff saw C1 walking behind the guardian in the side yard through the window, but saw S1 walking out the door behind them, that is why S1 was the staff who brought C1 in. Center director corroborated C1 couldn't have been outside more than 5 minutes as the guardian who C1 followed had signed their children out at 05:20PM, and C1 was signed out at 05:25PM. Type B deficiency is being issued on the attached 809-D page.

During the course of the investigation LPA Identified an area being used "the side yard" which is not identified on the facility sketch. The side yard is currently used as a walk way to the preschool play yard. LPA did not observe any area of concern on the side yard, which is enclosed. LPA requested director to submit updated facility sketch.

A notice of site visit was given and must remain posted for 30 days. Failure to do so will result in a civil penalty of $100. Report was read and reviewed with Director, Jaclyn Smith.
NAME OF LICENSING PROGRAM MANAGER: Leslie Lepori
NAME OF LICENSING PROGRAM ANALYST: Elpidia Hernandez Torres
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/29/2025
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 3
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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Document Has Been Signed on 05/29/2025 05:42 PM - It Cannot Be Edited


Created By: Elpidia Hernandez Torres On 05/29/2025 at 05:08 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: LITTLE FLOWERS MONTESSORI
FACILITY NUMBER: 485407185

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/29/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/05/2025
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision (1) No child(ren) shall be left without the supervision of a teacher at any time...
This was not met as evidence by...
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Center Director reported, all doors leading to the outside have an alarm attached that goes off to indicate the door has been opened. A mass email was sent out to all families to remind them to close the door behind them. Center director reported she will re-train staff to position themselves by the doors to ensure children don't go out the side yard without teacher supervision.
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Based on self-reported UIR, and interviews conducted, C1 followed a guardian out into the side yard. S1 only went out to get C1, when S1 observed a shadow through the window. This poses a potential 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.
Leslie Lepori
NAME OF LICENSING PROGRAM MANAGER:
Elpidia Hernandez Torres
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/29/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/29/2025


LIC809 (FAS) - (06/04)
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