283009779-5-29-2019-01-CC-KOCL-BCMNPZ-20190529103909

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 283009779
Report Date: 05/29/2019
Date Signed: 05/29/2019 10:39:19 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME:	WAGONER, MELINDA FCCH		FACILITY NUMBER:	283009779
ADMINISTRATOR:	MELINDA WAGONER		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(707) 255-4659
CITY:	NAPA	STATE: CA	ZIP CODE:	94559
CAPACITY:	14	CENSUS: 0	DATE:	05/29/2019
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Melinda Wagoner		TIME COMPLETED:	10:53 AM

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	A change of location inspection was conducted today by Licensing Program Analyst (LPA) Kevin O'Connell. The licensee was previously licensed at facility 283008482. The licensee is requesting a license for a capacity of 14. Services will be provided Monday-Sunday 5:30am- 11:00pm. The Licensee stated she understands that providing 24 hour consecutive care is prohibited. The residence is a three bedroom/ two bathroom, single-story house. There are five adults living in the home. The Licensee was advised that all adults residing or working at the facility must have a criminal background clearance on file with CCLD. All minors residing in the home must be fingerprinted within 30 days of reaching their 18th birthday and obtain a TB clearance. The Licensee stated she is aware of the immediate civil penalty for adults working or residing in the home without a criminal record clearance. The family room, Living room, kitchen and hallway bathroom will be used for childcare. The off limits areas are the garage, made inaccessible by a key bolt lock and the bedrooms made inaccessible by a gate in the hallway. The children will use the home's front yard (which is not fenced) and the park across the street as the outdoor play area with qualified adult supervision. Poisons, if any, will be key locked in the off limits, back yard potting shed. The home appears to be clean and orderly at this time and will remain so during child care hours. There is a working telephone. The cleaning supplies and medicines are stored out of the reach of children. Knives and other sharp items are inaccessible. Applicant states that there are no firearms or dangerous weapons and none were observed. The children in care will have access to age appropriate toys and equipment. The home is equipped with a working smoke detector, carbon monoxide detector and fire extinguisher rated at least 2A10BC. There are no bodies of water on the property.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Kevin O'Connell	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2019

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: WAGONER, MELINDA FCCH	FACILITY NUMBER: 283009779
	VISIT DATE: 05/29/2019

NARRATIVE

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Applicant will carry liability Insurance. Proof of control of property is on file. Parent's rights are and shall be posted. Emergency drills must be conducted at least once every six months and the date and time documented. Children's records to be maintained will be reviewed. The roster is to remain current at all times. Unusual Incident Report procedures were explained, to include notification before close of next business day and follow-up with written report within seven days. The Licensee will maintain current Pediatric CPR and First Aid. The Licensee shall be present in the home and shall ensure that children in care are supervised by a fingerprinted adult with current Pediatric CPR and First Aid certification. The Licensee understands that children may only be transported by adults with a criminal record clearance and are never to be left unattended in a vehicle. The Licensee clearly understands the maximum number of children for whom care can be provided and the limitations on the number of infants (birth to age 2) that may be cared for and when two of the children in care must be school aged. Smoking is prohibited at all times in those areas where children are present. The Licensee understands the responsibility to read and have knowledge of the laws and regulations for operation of a family child care home. Forms and regulations must be obtained from the website. http://ccld.ca.gov. Megan's Law web site was provided (http://www.meganslaw.ca.gov). The Licensee understands that any authorized employee of the Department may enter and inspect the facility with or without advance notice. This report was reviewed and discussed with the Licensee. A Child Care Provider Guides to Safe Sleep and the effects of lead exposure were provided and discussed. Any proposed changes to the physical plant, telephone number, or change of address shall be immediately reported to the Department. The following must be approved before licensure: a picture of a lock on the off limits potting shed for poisons, waiver approval for front yard use.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Kevin O'Connell	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2019

LIC809 (FAS) - (06/04)

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