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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493004901
Report Date: 12/12/2024
Date Signed: 12/12/2024 12:25:26 PM

Document Has Been Signed on 12/12/2024 12:25 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:W. H. PEPPER PRESCHOOL INC.FACILITY NUMBER:
493004901
ADMINISTRATOR/
DIRECTOR:		TARA SMITHFACILITY TYPE:
850
ADDRESS:627 F STREETTELEPHONE:
(707) 762-8151
CITY:PETALUMASTATE: CAZIP CODE:
94952
CAPACITY: 25TOTAL ENROLLED CHILDREN: 25CENSUS: 20DATE:
12/12/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:06 PM
MET WITH:Tara SmithTIME VISIT/
INSPECTION COMPLETED:
12:33 PM
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Licensing Program Analyst (LPA), Robert Maciel made an unannounced Plan of Correction (POC) visit and met with Director, Tara Smith (S1), for the purpose of following up on an outstanding POC that were due by 04/05/2024. During the annual inspection on 03/05/2024, the facility was cited for staff 2 (S2) not possessing a current mandated reporter training certificate.

During today's visit, LPA observed 20 children in care. LPA requested facility records. Record review showed that staff 2 (S2) possessed a current mandated reporter training certificate with a completion date of 3/6/2024 which satisfies the plan of correction. LPA gave Letter of Deficiency Citations Cleared to Director.

No deficiencies were cited during today's visit. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director, Tara Smith.
SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Robert Maciel
LICENSING EVALUATOR SIGNATURE: DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/12/2024
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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