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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173010131
Report Date: 03/23/2022
Date Signed: 03/23/2022 10:40:42 AM


Document Has Been Signed on 03/23/2022 10:40 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:PISENO, STEPHANIE FCCHFACILITY NUMBER:
173010131
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
03/23/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Stephanie PisenoTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Glenn Ouye and Sebastian Phouthavong arrived to conduct a case management visit for a change of capacity. The licensee is going from a small to a large family child care home. The approved fire inspection was received from the Lake County Fire Inspector on March 14, 2022.

LPA's verified a functioning smoke and carbon monoxide detector. The facility also has a charged fire extinguisher rated at 2A10BC. The pull station is in the nap room play area.

LPA's also inspected the outdoor play area, The play area is on a terraced backyard and is fully fenced. LPA Ouye suggested the licensee install a hand railing on the stairs and a gate at the bottom of the stairs. The capacity and ratio handout was provided to the licensee and discussed.

The facility is approved as a large family child care home effective March 23, 2022.

No deficiencies were cited during the inspection,
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Glenn OuyeTELEPHONE: (707) 588-5042
LICENSING EVALUATOR SIGNATURE:
DATE: 03/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/23/2022
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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