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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483001308
Report Date: 08/26/2022
Date Signed: 08/26/2022 02:47:47 PM


Document Has Been Signed on 08/26/2022 02:47 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:GRAVES, MARIA FAMILY CHILD CARE HOMEFACILITY NUMBER:
483001308
ADMINISTRATOR:GRAVES, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 557-7473
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY:12CENSUS: 3DATE:
08/26/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Maria Graves - LicenseeTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA), Melchisedeck Augustin made an unannounced Plan of Correction (POC) visit to follow up on a type B deficiency that was cited on 08/11/22. On 08/11/22, the facility was cited because the facility outdoor wooden patio deck that is on the main which is on the second floor had several loose screws, railings and deck posts, and Licensee did not comply with California Code of Regulations, 102417(g). Between 08/16/22 through 08/18/22, the Licensee submitted several POCs to clear several other violations, and LPA previously provided a POC Clearance Letters to the Licensee.

During today's inspection, LPA inspected the deck which revealed that some sections of deck railings had been fortified, however; several other sections were either still loose and not sturdy or was not secured to the wall. The POC for the deficiency is due by 08/25/22 and the Licensee requested additional time over the weekend to allow her to either fortify or secure the wood deck, and the facility's POC due date is extended through 08/28/22. LPA discussed with Licensee that if the facility did not correct the deficiency by the POC due date, the facility may be subject to assessment of civil penalty for not correcting deficiency. Additionally, the Licensee furnished a current EMSA approved pediatric CPR/First Aid certificate and Licensee is scheduled to attend an EMSA approved pediatric First Aid training prior to the deficiency POC due date which is on 09/08/22.

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 were no violation(s) of the California Code of Regulations, Title 22; Division 12 were cited during today’s visit.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:
DATE: 08/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/26/2022
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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