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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 233009158
Report Date: 11/15/2024
Date Signed: 11/15/2024 02:59:28 PM

Document Has Been Signed on 11/15/2024 02:59 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:VERDOT, KASIE FCCHFACILITY NUMBER:
233009158
ADMINISTRATOR/
DIRECTOR:
VERDOT, KASIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 972-5102
CITY:UKIAHSTATE: CAZIP CODE:
95482
CAPACITY: 14TOTAL ENROLLED CHILDREN: 9CENSUS: 9DATE:
11/15/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:47 AM
MET WITH:Kasie VerdotTIME VISIT/
INSPECTION COMPLETED:
03:11 PM
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An unannounced visit was made to the facility today by Licensing Program Analyst (LPA) Robert Maciel. A review of staff records on 10/30/2024 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated. There are currently three adults living in the home.

During today’s inspection the home and grounds were toured. The licensee was supervising nine children. The facility’s operating hours are Monday - Friday 7:45am - 5:15pm. The floor plan submitted by the licensee was reviewed and verified. The children will have access to the play room, the 2nd kitchen, the hallway bathroom, the dining room, the living room, and the backyard. The off-limits areas of the home are the four 1st floor bedrooms, the kitchen, the garage and the bedroom on the 2nd floor. The off-limits areas of the home were made inaccessible by door locks, plastic doorknob covers, and child gates. The licensee stated there is a working telephone in the home. The licensee’s pediatric CPR and First Aid training certificate was reviewed and expires August 2025. 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. 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. The Licensee states that poisons are not stored on the premises. The regulation that poisons are to be locked using a key or combination lock was reviewed.

Continued on LIC809-C
Erin VirruetaTELEPHONE: (530) -89-4325
Robert MacielTELEPHONE: (707) 588-5026
DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2024
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 4
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: VERDOT, KASIE FCCH
FACILITY NUMBER: 233009158
VISIT DATE: 11/15/2024
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The roster of children in care was reviewed and was current. The licensee has not conducted an emergency drill within the past six months; last drill was documented on 5/6/2024. The home's backyard is fully fenced. There were no pools or other bodies of water observed. 5 children's records were reviewed at 1:36 PM and contained all records as required. Facility and personnel files were reviewed at 1:28 PM and contained all records as required.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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 (USDOJ) 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, available at: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

On this date, 10/30/2024, 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.

Continued on LIC809-C
SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) -89-4325
LICENSING EVALUATOR NAME: Robert MacielTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2024
LIC809 (FAS) - (06/04)
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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: VERDOT, KASIE FCCH
FACILITY NUMBER: 233009158
VISIT DATE: 11/15/2024
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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, Kasie Verdot. During the exit interview, the Licensee, Kasie Verdot, 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. Failure to do so will result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) -89-4325
LICENSING EVALUATOR NAME: Robert MacielTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 11/15/2024 02:59 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: VERDOT, KASIE FCCH

FACILITY NUMBER: 233009158

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 11/15/2024
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not conduct an emergency drill within the past six months which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/22/2024
Plan of Correction
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Licensee stated she would perform a disaster drill, record it, and send a copy of the drill log to LPA by email at robert.maciel@dss.ca.gov. Additionally, Licensee stated she would move the drill log to the fridge in the second kitchen to more easily observe the dates of the drills.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Erin VirruetaTELEPHONE: (530) -89-4325
Robert MacielTELEPHONE: (707) 588-5026

DATE: 11/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/15/2024

LIC809 (FAS) - (06/04)
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