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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483008971
Report Date: 06/23/2022
Date Signed: 06/23/2022 04:19:14 PM


Document Has Been Signed on 06/23/2022 04:19 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:CURTIS, LATASHA FCCHFACILITY NUMBER:
483008971
ADMINISTRATOR:CURTIS, LATASHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 421-8106
CITY:SUISUN CITYSTATE: CAZIP CODE:
94585
CAPACITY:14CENSUS: 12DATE:
06/23/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Licensee Latasha Curtis TIME COMPLETED:
04:25 PM
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Licensing Program Analyst (LPA) Elpidia Hernandez Torres arrive to the facility to conduct a Plan Of Correction visit. On 06/02/2022 during an annual inspection Licensee nor assistant were able to produce a valid mandated reporter training certificate AB 1207 and a Type B deficiency was cited. During that inspection there were six children who did not have an immunization record on file or transcribed on the blue CDPH 286 sheet a Type B deficiency was cited. Both deficiencies had a POC of 06/16/2022. When LPA arrived on 06/23, licensee was able to show AB 1207 mandated training certificates for both her self and assistant. Licensee's certificate expires on 07/15/2022, and assistant's on 06/2024. Of the six children that were missing immunization records/ CDPH 286 blue sheet; two of the children have not been in attendance since licensee asked for records, one of them has an appointment on 06/28/2022 to get immunizations, and one of them still has not given licensee records based on licensee's confusion with what that child's record needed. The remaining two children had the blue CDPH 286 completed. LPA Hernandez Torres cleared both deficiencies and printed Cleared POC for licensee.

No deficiencies cited at this time in the areas observed, Notice of site visit shall be posted for 30 days.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Elpidia Hernandez TorresTELEPHONE: (707) 771-5568
LICENSING EVALUATOR SIGNATURE:
DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/23/2022
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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