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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 490170634
Report Date: 03/01/2023
Date Signed: 03/02/2023 02:27:06 PM

Document Has Been Signed on 03/02/2023 02:27 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:MAZZA, PAMELA FAMILY CHILD CARE HOMEFACILITY NUMBER:
490170634
ADMINISTRATOR:MAZZA, PAMELAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 539-7461
CITY:SANTA ROSASTATE: CAZIP CODE:
95409
CAPACITY: 12TOTAL ENROLLED CHILDREN: 6CENSUS: 1DATE:
03/01/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:04 AM
MET WITH:Pamela MazzaTIME COMPLETED:
10:45 AM
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This report has been amended to update the time of the informal conference to the correct time: 10:00am on March 9, 2023.

A Case Management inspection was conducted by Licensing Program Analyst (LPA) Amy Strother and Licensing Program Manager (LPM) Alexis Hollon as a follow up to a case management inspection conducted on 02/14/23 and potential physical plant hazards that were reported to the Department on 02/22/23. LPA and LPM met with Licensee, Pamela Mazza (L1). During today’s inspection, the facility was toured, LPA requested records and an interview was conducted with L1. L1 was not able to provide the records requested, including a current roster of children in care. At 9:20am L1 stated that she doesn’t believe she was given any paperwork and doesn’t not know where it is.

L1 was notified with a printed letter and verbal explanation, of an informal conference that she is to attend on 03/09/23 at 10:00am to be held at the Santa Rosa Regional Office – 1450 Neotomas Avenue, Suite 100, Santa Rosa, CA 95405 to discuss a plan for compliance addressing L1’s current deficiencies.

This report was reviewed and discussed with Licensee, Pamela Mazza.

No additional deficiencies were issued during today’s inspection.

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

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE: DATE: 03/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/01/2023
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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