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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 283009308
Report Date: 04/05/2023
Date Signed: 04/05/2023 01:19:18 PM


Document Has Been Signed on 04/05/2023 01:19 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 RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:MONERO, KIMBERLEE FCCHFACILITY NUMBER:
283009308
ADMINISTRATOR:MONERO, KIMBERLEEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 416-3316
CITY:AMERICAN CANYONSTATE: CAZIP CODE:
94503
CAPACITY:14CENSUS: 1DATE:
04/05/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:52 AM
MET WITH:Kimberlee MoneroTIME COMPLETED:
01:30 PM
NARRATIVE
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An annual required inspection was made to the facility by Licensing Program Analysts (LPA)s, Mindy Mohr and M. Augustin. LPAs met with Licensee, Kimberlee Monero. A review of staff records 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 four adults living in the home. 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

During the inspection the home was toured inside and outside. The Licensee was supervising 1 child and operating within the licensed capacity and ratio requirements. The facility’s operating hours are Mon - Fri 7:00am - 3:00pm. The floor plan submitted by the licensee was reviewed and verified. The off-limits areas of the home is the entire upper floor and the garage. The garage was accessible, a slip on door knob cover or lock is needed to keep area off limits. Off-limit area to the second floor is made inaccessible by a child safety gate at the bottom of the stairs. The on-limit areas include the living room, dining room, kitchen, family room and backyard. There were safe toys and equipment in the facility but they were unavailable to the children in care. There is a working telephone in the home. The licensee’s pediatric CPR and First Aid certifications were reviewed and expire on 07/17/2023. Mandated Reporter training certificate expired. Items which could pose a danger to children (such as detergents, cleaning compounds, medications, etc.) were observed to be accessible to children in care. Licensee took positive steps and immediately made these items inaccessible. Licensee stated that no poisons are stored in the home and none were observed during today's inspection. LPAs observed a working smoke detector, carbon monoxide detector and fire extinguisher, rated at least 2A10BC, in the home. The roster of children in care was reviewed and was current. Licensee stated to not have any firearms and/or other dangerous weapons and none were observed during the inspection. The home's backyard is fully fenced. There were no pools or other bodies of water observed.

(Continued on LIC 809-C)

SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melinda MohrTELEPHONE: (707) 494-2125
LICENSING EVALUATOR SIGNATURE:
DATE: 04/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/05/2023
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


Document Has Been Signed on 04/05/2023 01:19 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 RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405


FACILITY NAME: MONERO, KIMBERLEE FCCH

FACILITY NUMBER: 283009308

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 04/05/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(b)
Operation of A Family Child Care Home
(b) The home shall be kept clean and orderly, with heating and ventilation for safety and comfort.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPAs observations of accessible cleaning compounds in the living room, under the kitchen and bathroom sinks while one child was in care. The floors throughout the accessible areas of the home were dirty with crumbs and dust. Areas of the home were cluttered with items such as fish tank accessories. The kitchen had a garbage can open and full, and a box of garbage on the floor. The licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/17/2023
Plan of Correction
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Prior to Licensees departure Licensee initiated cleaning and made all cleaning compounds inaccessable. Licensee stated she will put the garbage can under the counter and move the recycle box into the pantry.
Type B
Section Cited
HSC
1596.8662(b)(1)
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
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Based on Licensee's statement she acknowledged she did not have a current mandated reporter training certificate. The licensee did not comply with the section cited which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/20/2023
Plan of Correction
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Licensee agreed to complete the online training module at mandatedreporterca.com. Licensee will submit certificate upon completion by 5-20-2023
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: Melinda MohrTELEPHONE: (707) 494-2125
LICENSING EVALUATOR SIGNATURE:
DATE: 04/05/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/05/2023
LIC809 (FAS) - (06/04)
Page: 2 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 RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: MONERO, KIMBERLEE FCCH
FACILITY NUMBER: 283009308
VISIT DATE: 04/05/2023
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One child's (C1) record was reviewed at 11:17 am. The record contained the consent for emergency treatment and immunization records. No staff were reviewed as there was no staff present.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page 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. Other links to resources were provided as well.

Incidental Medical Services (IMS) policy was discussed. 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 (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: http://www.ada.gov/childqanda.htm

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with the Licensee. The following violations of the California Code of Regulations, Title 22; Division 12, were observed during today’s visit.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melinda MohrTELEPHONE: (707) 494-2125
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023
LIC809 (FAS) - (06/04)
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