493010560-4-10-2026-01-CC-YYAG-DSZSK7-20260410135617

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 493010560
Report Date: 04/10/2026
Date Signed: 04/10/2026 01:56:27 PM

Document Has Been Signed on 04/10/2026 01:56 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:	OLIVEIRA, FLAVIA & DAVID FCCH		FACILITY NUMBER:	493010560
ADMINISTRATOR/ DIRECTOR:	OLIVEIRA, FLAVIA & DAVID		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(707) 772-9113
CITY:	PETALUMA	STATE: CA	ZIP CODE:	94954
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 9	CENSUS: 7	DATE:	04/10/2026
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:34 AM
MET WITH:	Flavia and David Oliveira		TIME VISIT/ INSPECTION COMPLETED:	01:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	An unannounced visit was made to the facility today by Licensing Program Analyst (LPA) Y. Yang. A review of staff records on 04/10/2026 indicates that one individual who requires a caregiver background checks has not received their criminal record and child abuse index clearances or exemptions. The licensees' son turned 18 years of age in October 2025. Licensees were reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated. Due to this, a civil penalty is being assessed today. There are currently three adults living in the home. During today’s inspection the home and grounds were toured. The two licensees were supervising seven children and operating within ratio. The facility’s operating hours are 08:00am to 05:00pm, Monday through Friday. The floor plan submitted by the licensee was reviewed and verified. The children have access to the living room, dining room, hall bathroom, and bedroom #1, and backyard. The "off limits" areas of the home include the garage, kitchen, bedroom #2 and bedroom #3, and the master bathroom in bedroom #1. The off-limits areas of the home were made inaccessible by door locks and/or child gates. The home was at a comfortable indoor temperature. There were safe toys and equipment available for children. The licensee stated there is a working telephone in the home (the licensee's cell phone). The licensees' pediatric CPR and First Aid certificates both expires in August 2027. The licensees' California mandated reporter training certificates expired in September 2025. Items which could pose a danger to children (such as detergents, cleaning compounds, medications, etc.) were observed to be stored out of the reach of children at the time of the inspection. The LPA observed a working smoke detector, carbon monoxide detector, and fire extinguisher, rated at least 2A10BC, in the home. A fire/disaster drill has been performed within the past six months. The licensees stated that poisons, firearms, and ammunition are not stored on the premises. The home's backyard is fully fenced and on limits. There were no bodies of water observed on the premises during today's inspection visit and none shall be added without prior approval of the licensing agency. Continued on LIC 809-C

NAME OF LICENSING PROGRAM MANAGER: Melchisedeck Augustin
NAME OF LICENSING PROGRAM ANALYST: Yang Yang
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/10/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2026

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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Document Has Been Signed on 04/10/2026 01:56 PM - It Cannot Be Edited

Created By: Yang Yang On 04/10/2026 at 12:04 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: OLIVEIRA, FLAVIA & DAVID FCCH	FACILITY NUMBER: 493010560
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/10/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.871(c)(1)(A)

Administration of Child Day Care Licensing

Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on the licensees' statements and a review of personnel records, the licensee did not comply with Section 1596.871(c)(1)(A).The licensees stated that their son, Adult A1, who resides in the home, turned 18 years of age in October 2025 and has not obtained the required criminal record clearance and Child Abuse Central Index (CACI) clearance.The licensee also stated that Adult A1 is not a staff member and is not left alone with daycare children.This poses a potential risk to the health, safety, or personal rights of children in care.
	POC Due Date: 04/17/2026
	Plan of Correction
1 2 3 4	The licensees stated that Adult A1 will complete the Live Scan fingerprinting process and will submit proof of completion to the Department by 04/17/2026.The licensees also stated that they will submit an updated LIC 279 and a current TB clearance for Adult A1 by the same date.

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on the licensees’ statements and the LPA's personnel file review conducted on today’s date, the licensees did not comply with Section 1596.8662(b)(1) by failing to maintain a current California Mandated Reporter Training certificate.A review of records indicated that both licensees’ certificates expired in September 2025.This poses a potential risk to the health, safety, or personal rights of children in care.
	POC Due Date: 05/01/2026
	Plan of Correction
1 2 3 4	The licensee stated that they will renew their California Mandated Reporter Training certificate and will submit proof of completion to the Department by 05/01/2026.

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:

	Yang Yang
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/10/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2026

LIC809 (FAS) - (06/04)

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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: OLIVEIRA, FLAVIA & DAVID FCCH	FACILITY NUMBER: 493010560
	VISIT DATE: 04/10/2026

NARRATIVE

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Five children's record were reviewed during the inspection. The LPA reviewed completed infant 15 minute nap check logs and infant safe sleep plans. The LPA reviewed two personnel files. Item(s) were observed missing from both staff's records.

The LPA provided the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as a resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

The Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

The following violations of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. A civil penalty was assessed. Appeal Rights were provided. A notice of site visit was given to licensee and must remain posted in a prominent area for 30 days. Exit interview conducted and report was reviewed with the licensees, Flavia and David Oliveira. During the exit interview, the licensees confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

NAME OF LICENSING PROGRAM MANAGER: Melchisedeck Augustin
NAME OF LICENSING PROGRAM ANALYST: Yang Yang
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/10/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2026

LIC809 (FAS) - (06/04)

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