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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 233009419
Report Date: 11/04/2019
Date Signed: 11/05/2019 10:04:12 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:PITTMAN, JENNIFER FCCHFACILITY NUMBER:
233009419
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 6DATE:
11/04/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:57 AM
MET WITH:Jennifer Pittman, LicenseeTIME COMPLETED:
11:45 AM
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A case management inspection was made to the facility by Licensing Program Analyst (LPA), Mary Trinh to increase the facility capacity from a Small Family Child Care Home (FCCH) to a Large Family Child Care Home with capacity of 14. The facility was granted a fire clearance to operate as a Large Family Child Care Home by the Ukiah Fire Department on 09/26/2019 .
A review of staff records on the Licensing Information System (LIS) indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. There are currently one adult living in the home. The home and grounds were toured with Jennifer Pitman at 11 AM. The Licensee and Assistant was supervising 8 children, and operating within the licensed capacity and ratio requirements. Three of the children are under the Assistants care. No children were observed left in any parked vehicle. Operating hours are 7 am to 5:30pm, Mon-Fri.
The licensee understands that the facility cannot provide 24 hour child care services. The floor plan submitted by the licensee was reviewed and verified. Care is provided in the living room, dining room, kitchen, and hallway bathroom.
The off-limits areas of the home is one bedroom. The home is clean, orderly and comfortable. There are safe toys and equipment available for children. There is a working telephone in the home. The licensee has current pediatric CPR and First Aid certification, which expire in 05/18/2021. The Licensee and Assistant have the AB 1207 Mandated Reporter Training certificates. Items which could pose a danger to children (detergents, cleaning compounds, medications, etc.) are stored out of the reach of children. LPA did not observe any poisons. There is a working smoke detector, carbon monoxide detector and a charged fire extinguisher, rated at least 2A10BC, in the home. The licensee stated there are no firearms and/or other dangerous weapons in the home, and none were observed during today's inspection.
The children use the back yard as the outdoor play area and it is fully fenced. There were no pools or other bodies of water observed in the yard. The licensee is not providing Incidental Medical Services (IMS) to children in care. The Incidental Medical Services (IMS) policy was discussed with the licensee. Safe sleep concepts handout was given.
The increase in capacity is granted as of today 11/104/2019.
Notice of Site Visit shall be posted for 30 days from today's inspection.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Mary TrinhTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2019
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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