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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173008755
Report Date: 01/24/2020
Date Signed: 01/27/2020 09:59:22 AM

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:BLOCKER, SHERRI FCCHFACILITY NUMBER:
173008755
ADMINISTRATOR:BLOCKER, SHERRIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 413-3106
CITY:LAKEPORTSTATE: CAZIP CODE:
95453
CAPACITY:14CENSUS: 8DATE:
01/24/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Sherri Blocker, LicenseeTIME COMPLETED:
01:45 PM
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An Required inspection was made to the facility by Licensing Program Analyst (LPA), N. Cunningham. A review of staff records on 01/22/20 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

During today’s inspection the home and grounds were toured. The licensee was supervising eight children, and operating within the licensed capacity and ratio requirements. No children were observed left in any parked vehicle. The program is currently operating 7:00am – 05:30pm, Monday - Friday, January - December. The living room, play room, kitchen, one bedroom, and the bathroom are on-limits. "Off limits" areas are the master bed/bath and the entire downstairs. The home was observed to be clean and orderly and 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. 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. Licensee states there are no poisons in the home. The requirement that poisons be stored in a space locked with a key lock/combination lock was reviewed. The LPA observed a working smoke detector, carbon monoxide detector and fire extinguisher, rated at least 2A10BC, in the home. The licensee conducts emergency drill quarterly, last drill was documented on 11/2019. Firearms are locked according to regulation. There were no pools or other bodies of water observed. The children use the front yard which is fully fenced. Four children's (C1 - C4) records were reviewed at 12:30pm; current immunizations, Consent for Emergency Medical Treatment and Notification of Parent’s Rights forms were on file.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Nicolette CunninghamTELEPHONE: (707) 588-5056
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2020
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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: BLOCKER, SHERRI FCCH
FACILITY NUMBER: 173008755
VISIT DATE: 01/24/2020
NARRATIVE
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The licensee is not providing Incidental Medical Services (IMS) to children in care. The Incidental Medical Services (IMS) policy was discussed with the licensee. 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 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.

The following violation(s) of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Appeal Rights were provided. Upon receipt, licensee shall post, and provide copies, of this licensing report to parents/guardians of children in care at the facility, and to parents/guardians of children newly enrolled at the facility during the next 12 months. Licensee shall provide the copies to parents no later than the next business day or the next day the child is in care and use form LIC9224 for parents/guardians to sign, confirming report was received. LIC9224 is to be kept in each child's file.

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SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Nicolette CunninghamTELEPHONE: (707) 588-5056
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2020
LIC809 (FAS) - (06/04)
Page: 3 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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: BLOCKER, SHERRI FCCH
FACILITY NUMBER: 173008755
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/24/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/25/2020
Section Cited

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(a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: (2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment. This regulation was not met by evidence of:
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On 01/24/20 at approximately 12:20pm, LPA observed a three month old infant sleeping on a boppy on top of a train table in the playroom. The infant had a blanket wrapped around their body. This poses an immediate health and safety risk to children or child in care. LPA photographed the area the infant was sleeping in.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Nicolette CunninghamTELEPHONE: (707) 588-5056
LICENSING EVALUATOR SIGNATURE:
DATE: 01/24/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/24/2020
LIC809 (FAS) - (06/04)
Page: 2 of 3