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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010083
Report Date: 03/13/2025
Date Signed: 03/13/2025 03:17:59 PM

Document Has Been Signed on 03/13/2025 03:17 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:ACHIEVERSFACILITY NUMBER:
493010083
ADMINISTRATOR/
DIRECTOR:		HEATHER PETERSFACILITY TYPE:
850
ADDRESS:573 SUMMERFIELD ROADTELEPHONE:
(707) 539-6232
CITY:SANTA ROSASTATE: CAZIP CODE:
95405
CAPACITY: 90TOTAL ENROLLED CHILDREN: 39CENSUS: 31DATE:
03/13/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Sydney SoosTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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(The Administrator listed above, Heather Peters, has not been working at the facility since January 17, 2025 and is no longer the Administrator.)

Licensing Program Analyst (LPA) Amy Strother made an unannounced case management visit to the facility after receiving an Unusual Incident Report (UIR) on 02/28/25, regarding a possible violation of children’s personal rights occurring on 02/26/25. LPA met with Facility Representative, Director, Sydney Soos (D1).

During today’s visit, LPA toured the facility, 31 students were being supervised by 3 teachers, operating within the licensed capacity and ratio requirements. LPA interviewed D1, Staff 2 - Staff 5 (S2-S5). LPA reviewed staff files, requested and received a current roster of children in care, LIC9040 and current Personnel Report, LIC500, and other documents pertaining to the incident.

Due to insufficient information available at this time, the above incident needs further investigation. This report was reviewed and discussed with Center Director, Sydney Soos. Appeal Rights were provided.

There were no Title 22 deficiencies cited during today's inspection.

Notice of Site Visit shall be posted for 30 days from today's visit. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE: DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/13/2025
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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