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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173007927
Report Date: 12/13/2019
Date Signed: 12/13/2019 03:57:18 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:JORDAN, DARCIE FCCHFACILITY NUMBER:
173007927
ADMINISTRATOR:JORDAN, DARCIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 994-6803
CITY:LOWER LAKESTATE: CAZIP CODE:
95457
CAPACITY:14CENSUS: 10DATE:
12/13/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Darcie Jordan, LicenseeTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) N. Cunningham made an unannounced inspection at the facility. A review of staff records on 12/12/19 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. On November 25, 2019, the Licensee submitted a request to add an additional room which will be utilized as the main child care area. On December 11, 2019, the local fire inspector toured the room and approved the additional space. During todays inspection, LPA inspected the room and observed all areas of the space to be in compliance with Title 22 regulations. The room is approved for children to use. An updated facility sketch is on file.

The following information regarding ADA was provided: US Department of Justice 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, www.ada.gov/childqanda.htm. This report, as well as the AAP Guide to Safe Sleep Practices and The Effects of Lead Exposure brochures, were reviewed and discussed with the licensee. All licensing reports are public information and must be made available upon request for at least three years.

Notice of Site Visit shall be posted for 30 days from today's visit.

There were no Title 22 deficiencies cited during today's inspection.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Nicolette CunninghamTELEPHONE: (707) 588-5056
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2019
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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