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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483009446
Report Date: 09/09/2020
Date Signed: 09/09/2020 11:41:57 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:WINN, MARIA FCCHFACILITY NUMBER:
483009446
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: DATE:
09/09/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Maria WinnTIME COMPLETED:
11:30 AM
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The facility inspection was conducted via tele-inspection due to the Covid-19 state of emergency pandemic. The department has suspended all field operations and the applicant has agreed to conduct the video conference with LPA, (Licensing Program Analyst) Glenn Ouye.

This televisit inspection was conducted for a capacity increase. The licensee has been operating utilizing the statewide wavier. The capacity increase application was received on August 24, 2020. The fire clearance was received from the Fairfield Fire Dept on September 3, 2020.

The licensee toured LPA through the home via video feed using FaceTime. The home has operational smoke and carbon monoxide detectors which were tested and functional. A fire extinguisher rated at a minimum of 2A10BC was mounted just outside of the kitchen. The pull station fire alarm was wall mounted and observed during the video inspection. The licensee conducts monthly emergency disaster drills and showed LPA the posted documentation. LPA and licensee discussed child ratio requirements for a large FCCH.

The licensee is approved to operate as a large effective immediately, September 9, 2020. A new license will be issued to the licensee which reflects a large FCCH capacity of 14 children.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Glenn OuyeTELEPHONE: (707) 588-5042
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2020
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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