233008375-12-4-2024-01-CC-RMAL-DBN36U-20241204165854

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 233008375
Report Date: 12/04/2024
Date Signed: 12/04/2024 04:59:20 PM

Document Has Been Signed on 12/04/2024 04:59 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:	BROWN, REBECCA FCCH		FACILITY NUMBER:	233008375
ADMINISTRATOR/ DIRECTOR:	BROWN, REBECCA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(707) 462-8480
CITY:	UKIAH	STATE: CA	ZIP CODE:	95482
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 12	CENSUS: 10	DATE:	12/04/2024
TYPE OF VISIT:	Case Management - Annual Continuation	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:51 PM
MET WITH:	Rebecca Brown		TIME VISIT/ INSPECTION COMPLETED:	05:10 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	An unannounced visit was made to the facility today by Licensing Program Analyst (LPA) Robert Maciel. This visit is a continuation of an inspection that began on 11/15/24. During today’s inspection the home and grounds were toured. The licensee was supervising ten children. The licensee’s pediatric CPR and First Aid training certificate was reviewed and expires February 2025. The LPA observed a working smoke detector, carbon monoxide detector, and fire extinguisher, rated at least 2A10BC, in the home. The licensee stated that firearms and ammunition are not stored on the premises and none were observed by the LPA. In Bedroom 2, LPA observed child 1 (C1) sleeping with a sleep sack in a playpen. In the Daycare Room, LPA observed child 2 (C2) sleeping with blanket in a playpen. The roster of children in care was reviewed and was current. The licensee has conducted an emergency drill within the past six months; last drill was documented on 7/11/2024. The home's backyard is fully fenced. There were no pools or other bodies of water observed. 5 children's records were reviewed at 2:44 PM which revealed that C1 and C2's CDPH286 Immunization record were not up to date, the facility did not possess record of C1's LIC9227 Individual Infant Safe Sleep Plan, and that the facility did not perform sleep checks for C1 and C2 on 12/3/24 and 12/4/24. Facility and personnel files were reviewed at 3:02 PM which revealed that staff 1 (S1) did not possess a current mandated reporter training certificate or proof of immunization against measles and pertussis. Continued on LIC809-C

Erin Virrueta	TELEPHONE: (530) -89-4325
Robert Maciel	TELEPHONE: (707) 588-5026
	DATE: 11/27/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/27/2024

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 6

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: BROWN, REBECCA FCCH	FACILITY NUMBER: 233008375
	VISIT DATE: 12/04/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Page 2

On this date, 11/14/2024, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility address. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

The following Title 22 deficiencies were cited during today's inspection. See LIC809-D. Exit interview conducted and report was reviewed with the Licensee, Rebecca Brown. During the exit interview, the Licensee, Rebecca Brown, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Erin Virrueta	TELEPHONE: (530) -89-4325
LICENSING EVALUATOR NAME: Robert Maciel	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

LIC809 (FAS) - (06/04)

Page: 2 of 6

Document Has Been Signed on 12/04/2024 04:59 PM - It Cannot Be Edited

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: BROWN, REBECCA FCCH	FACILITY NUMBER: 233008375
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/04/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

Infant Safe Sleep

(b) Cribs or play yards shall be free from all loose articles and objects. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, LPA observed child 1 (C1) wearing a sleep sack while sleeping in a playpen in Bedroom 2 which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/18/2024
	Plan of Correction
1 2 3 4	Licensee stated she would write a statement attesting to her understanding of the Infant Safe Sleep Regulations and submit it to LPA by email at robert.maciel@dss.ca.gov

Section Cited

Infant Safe Sleep

An infant shall not be swaddled while in care. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, LPA observed child 2 (C2) sleeping with a blanket in a playpen in the Daycare Room which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/18/2024
	Plan of Correction
1 2 3 4	Licensee stated she would write a statement attesting to her understanding of the Infant Safe Sleep Regulations and submit it to LPA by email at robert.maciel@dss.ca.gov

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Erin Virrueta	TELEPHONE: (530) -89-4325
Robert Maciel	TELEPHONE: (707) 588-5026
	DATE: 12/04/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

LIC809 (FAS) - (06/04)

Page: 3 of 6

Document Has Been Signed on 12/04/2024 04:59 PM - It Cannot Be Edited

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: BROWN, REBECCA FCCH	FACILITY NUMBER: 233008375
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/04/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

Infant Safe Sleep

The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not record 15-minute sleep checks for child 1 (C1) and child 2 (C2) which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/18/2024
	Plan of Correction
1 2 3 4	Licensee stated she would submit a week of sleep checks for C1 and C2 to LPA by email at robert.maciel@dss.ca.gov.

Section Cited

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, staff 1 (S1) did not possess a current mandated reporter training certificate which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/18/2024
	Plan of Correction
1 2 3 4	Licensee stated she would obtain S1's mandated reporter training certificate and submit a copy to LPA by email at robert.maciel@dss.ca.gov.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Erin Virrueta	TELEPHONE: (530) -89-4325
Robert Maciel	TELEPHONE: (707) 588-5026
	DATE: 12/04/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

LIC809 (FAS) - (06/04)

Page: 4 of 6

Document Has Been Signed on 12/04/2024 04:59 PM - It Cannot Be Edited

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: BROWN, REBECCA FCCH	FACILITY NUMBER: 233008375
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/04/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

Administration of Child Day Care Licensing

(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the facility did not possess proof of staff 1's (S1) immunization against measles and pertussis. which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/18/2024
	Plan of Correction
1 2 3 4	Licensee stated she would obtain proof of immunization for S1 and send a copy to LPA by email at robert.maciel@dss.ca.gov.

Section Cited

Immunizations

(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. (1) This requirement includes updating each child's PM 286 (6/95) when the child is due to receive required immunizations after enrollment in the family day care home. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, Child 1's and Child 2 's(C2) CDPH286 Immunization record were not up to date which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/18/2024
	Plan of Correction
1 2 3 4	Licensee stated she would obtain record of C1 and C2's current immunizations, update the CDPH286 forms, and send a copy to LPA by email at robert.maciel@dss.ca.gov.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Erin Virrueta	TELEPHONE: (530) -89-4325
Robert Maciel	TELEPHONE: (707) 588-5026
	DATE: 12/04/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

LIC809 (FAS) - (06/04)

Page: 5 of 6

Document Has Been Signed on 12/04/2024 04:59 PM - It Cannot Be Edited

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: BROWN, REBECCA FCCH	FACILITY NUMBER: 233008375
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/04/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

Infant Safe Sleep

An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the facility did not possess a complete LIC9227 Individual Infant Sleeping Plan for C1 which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/18/2024
	Plan of Correction
1 2 3 4	Licensee stated she would obtain a compelte LIC9227 and send a copy to LPA by email at robert.maciel@dss.ca.gov.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Erin Virrueta	TELEPHONE: (530) -89-4325
Robert Maciel	TELEPHONE: (707) 588-5026
	DATE: 12/04/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

LIC809 (FAS) - (06/04)

Page: 6 of 6