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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010661
Report Date: 01/08/2026
Date Signed: 01/08/2026 10:22:31 AM

Document Has Been Signed on 01/08/2026 10:22 AM - 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:MATTIE WASHBURN DISTRICT PRESCHOOLFACILITY NUMBER:
493010661
ADMINISTRATOR/
DIRECTOR:		JESSICA BORLANDFACILITY TYPE:
860
ADDRESS:75 PLEASANT AVENUETELEPHONE:
(707) 837-7705
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 0DATE:
01/08/2026
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:10 AM
MET WITH:Facility Representative, Jessica BorlandTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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On 01/08/2026, Licensing Program Analyst, Sebastian Phouthavong met with the Facility Representative, Jessica Borland. The purpose of the visit was an announced pre-licensing inspection at the facility to ensure the health, safety, and personal rights as required by Title 22 and Health and Safety Regulations governing California Child Care Centers will be met. The Facility has an existing Preschool program.

Applicant is requesting to be increase the facility’s capacity to 160 preschool children. The facility operating hours are Monday to Friday 7:30AM to 5:30PM. The fire clearance was granted on 12/08/2025 by the Santa Rosa Fire Department. LPA toured and measured the on-limits areas and classrooms located at the facility. The facility has a total of 5 classrooms. The facility is located on the Mattie Washburn elementary school campus and childcare services will no longer be provided in classroom 7A and will be provided in the newly built classrooms.

Preschool Classroom measurements are:

The indoor total measurements contain a total of 5608.17 square feet, which will accommodate applicant’s request for 160 Preschool children.

Preschool Outdoor Play measurements are:

Outdoor total measurements contain a total of 16510.00 square feet, which will accommodate applicant’s request for 160 Preschool children.

Report continued on LIC 809-C.

NAME OF LICENSING PROGRAM MANAGER: Melinda Mohr
NAME OF LICENSING PROGRAM ANALYST: Sebastian Phouthavong
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 01/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/08/2026
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 5
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: MATTIE WASHBURN DISTRICT PRESCHOOL
FACILITY NUMBER: 493010661
VISIT DATE: 01/08/2026
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Report continued from LIC 809 - Page 2

All indoor and outdoor activity space utilized for the children were inspected today. LPA informed applicant that staff are required to maintain direct visual supervision of the children at all times during indoor and outdoor activities. Classrooms were observed to be clean, safe, sanitary and in good repair. All outdoor and indoor passageways and other areas of potential hazard were free of obstruction. A comfortable temperature for children shall be maintained at all times.

Furniture and equipment were observed to be maintained in good condition, free of sharp, loose, or pointed parts. All materials and surfaces accessible to children, including toys, shall be free of toxic substances. All play equipment and materials used by children were observed to be age appropriate. Tables and chairs were observed to meet the needs of the children. There are 11 toilets and 11 sinks available for preschool children. Isolation area for sick children will be the office; children have access to staff bathroom and remain separated from remaining children.

Facility has five preschool classrooms; Classroom 1, 2, 3, 4, 5. Applicant stated that the facility will provide three meals a day, including snacks. Meals will be prepped by Mattie Washburn elementary school campus and delivered to the classrooms.

The Applicant shall take measures to keep the center free of flies, other insects, and rodents. All containers used for storage of solid wastes, including moveable bins, shall have a tight-fitting cover that is kept on. LPAs observed no fireplace or open face heaters. Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children. There is a fully equipped first aid kit located at the facility. There is an operational carbon monoxide detector on site.

Drinking water is readily available for the children in the facility via water foundation/refill station. Applicant also stated that children bring their own water bottles.

LPA observed the facility has fully fenced outdoor playground. Outdoor areas were free of hazards including, holes, broken glass dry grasses, and other debris that pose a fire hazard. Any construction or equipment that could pose a hazard in the outdoor activity areas shall be made inaccessible to children in care. Shade was provided by trees. The playground and classrooms are enclosed by fencing at least 4 feet high. There are areas with temporary fencing, however permanent fencing will be added. There are sufficient outdoor age-appropriate toys and play equipment available on the playground. There is adequate cushioning in fall zones provided turf that can absorb a fall.

Report continued on LIC 809-C.

NAME OF LICENSING PROGRAM MANAGER: Melinda Mohr
NAME OF LICENSING PROGRAM ANALYST: Sebastian Phouthavong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2026
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: MATTIE WASHBURN DISTRICT PRESCHOOL
FACILITY NUMBER: 493010661
VISIT DATE: 01/08/2026
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Report continued from LIC 809-C - Page 3

Facility Representative was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes 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) or (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.

LPAs reviewed with licensee representative the LIC 311A, Records to Be Maintained at The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

Facility Representative was informed of the MyChildCarePlan.org site, 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.

Report continued on LIC 809-C.

NAME OF LICENSING PROGRAM MANAGER: Melinda Mohr
NAME OF LICENSING PROGRAM ANALYST: Sebastian Phouthavong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2026
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: MATTIE WASHBURN DISTRICT PRESCHOOL
FACILITY NUMBER: 493010661
VISIT DATE: 01/08/2026
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Report continued from LIC 809-C - Page 4

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

A notice of site visit was given to the licensee representative and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted and report was reviewed with . Facility Representative,



This facility is approved for the increase of capacity effectived today's date, 01/08/2026. Facility Representative stated that operation will start on 01/12/2025.
NAME OF LICENSING PROGRAM MANAGER: Melinda Mohr
NAME OF LICENSING PROGRAM ANALYST: Sebastian Phouthavong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2026
LIC809 (FAS) - (06/04)
Page: 5 of 5