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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493008727
Report Date: 08/11/2026
Date Signed: 08/11/2026 12:27:37 PM

Document Has Been Signed on 08/11/2026 12:27 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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:4CS GOLD RIDGE PRESCHOOLFACILITY NUMBER:
493008727
ADMINISTRATOR/
DIRECTOR:		COPELAND, JENNYFACILITY TYPE:
850
ADDRESS:1455 GOLF COURSE DRIVETELEPHONE:
(707) 586-1253
CITY:ROHNERT PARKSTATE: CAZIP CODE:
94928
CAPACITY: 71TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/11/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:56 AM
MET WITH:Michelle Capistrand, Assistant Director of Preschool Programs TIME VISIT/
INSPECTION COMPLETED:
12:27 PM
NARRATIVE
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An unannounced case management inspection was conducted by Licensing Program Analyst (LPA) Y. Yang in response to a self-reported Unusual Incident Report (UIR) involving an allegation of a personal rights violation. The facility submitted the UIR to Community Care Licensing (CCL) on July 2, 2026. The purpose of today's visit was to review the facility's response to the allegation, evaluate the actions taken by the administration, and gather additional information regarding the reported incident.

During the inspection today, the LPA met with the agency's Assistant Director of Preschool Programs, Michelle Capistrand to discuss the circumstances surrounding the allegation and follow up actions. The Site Supervisor, Heather Peters originally reported to the Department that on June 12, 2026, a concerned party informed her that they had observed staff member S1 holding, leading, and pulling children by their wrists or arms while transitioning them to diapering and toileting routines on May 28, 2026, and June 10, 2026. According to the concerned party, the children appeared to resist these actions. However, according to the Site Supervisor, the concerned party did not identify the children involved or provide additional identifying information at the time

The Site Supervisor reported that she immediately notified her supervisor, Assistant Director of Preschool Programs, Michelle Capistrand, upon learning of the allegation. In response, the facility initiated an internal investigation to determine the validity of the reported concerns. As part of the investigation, written statements were obtained from staff members, and facility administration conducted individual interviews with employees who worked alongside S1 during the relevant time period. To obtain additional information regarding the facility's investigation and administrative response, the LPA also conducted an interview with the Assistant Director of Preschool Programs on July 30, 2026. The purpose of these interviews was to determine whether any staff had witnessed similar interactions or had additional information regarding the allegation. (Continued on next page)

Melchisedeck Augustin
Yang Yang
DATE: 08/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/11/2026
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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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: 4CS GOLD RIDGE PRESCHOOL
FACILITY NUMBER: 493008727
VISIT DATE: 08/11/2026
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During today's inspection, the LPA reviewed the facility's investigative documentation, including staff statements and interview notes, and discussed the findings with the Assistant Director of Preschool Programs. In addition to reviewing documentation, the LPA made a case management visit on July 30, 2026 for an unrelated purpose and observed classroom operations and staff interactions with children to assess supervision practices, transition routines, and staff handling techniques. No concerns related to children's personal rights or inappropriate handling were observed during that day’s inspection. During today’s case management visit, there were no daycare children in care. The Assistant Director of Preschool Programs informed the LPA that all children have been disenrolled from this location in anticipation of this facility’s permanent closure on August 31, 2026.

Based on available information, interviews conducted, and the LPA’s observations, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is unsubstantiated at this time. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Assistant Director of Preschool Programs, Michelle Capistrand. There were no Title 22 deficiencies cited during today's inspection.

NAME OF LICENSING PROGRAM MANAGER: Melchisedeck Augustin
NAME OF LICENSING PROGRAM ANALYST: Yang Yang
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2026
LIC809 (FAS) - (06/04)
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