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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483009446
Report Date: 03/25/2024
Date Signed: 03/25/2024 12:46:03 PM


Document Has Been Signed on 03/25/2024 12:46 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:WINN, MARIA FCCHFACILITY NUMBER:
483009446
ADMINISTRATOR:WINN, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 396-8044
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY:14CENSUS: 9DATE:
03/25/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:18 PM
MET WITH:Licensee Maria WinnTIME COMPLETED:
12:50 PM
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During the course of investigation Licensing Program Analyst ( LPA) Elpidia Hernandez Torres received evidence of an infant under 12 months sleeping in a car seat. Interviews also revealed there was another occasion where an infant under 12 months was asleep in a swing for at least 15 minutes before they were moved to a crib or portable crib. Interviews revealed these incidents occurred in 2023.

The California Code of Regulations, Title 22, Division 12 & Chapter 1, section 102425(i) is being cited on the attached 809-D. Exit Interview was conducted, report was reviewed with licensee. Notice of site visit was given and must remain posted for 30 days. Appeal rights were given.

SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Elpidia Hernandez TorresTELEPHONE: (707) 771-5568
LICENSING EVALUATOR SIGNATURE:
DATE: 03/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/25/2024
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 2


Document Has Been Signed on 03/25/2024 12:46 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405


FACILITY NAME: WINN, MARIA FCCH
FACILITY NUMBER: 483009446

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/25/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/08/2024
Section Cited
CCR
102425(i)

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If an infant falls asleep before being placed in a crib or play yard, the provider shall move the infant to a crib or play yard as soon as possible. This was not met as evidence by. . .
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I am not going to stay it happened because it didn't happen. If an infant falls asleep in the swing then we immediately move the infant to the crip or portable crib.
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. . . based on interviews conducted there were at least two occasions in 2023 where an infant under 12 months was asleep in a car seat, and another occasion where an infant was asleep in an infant swing. This poses a potential health and safety risk to children in care.
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The Licensee reported she puts infants in the portable crib as soon as she goes to sleep. There are no carseats in the home.

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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: Elpidia Hernandez TorresTELEPHONE: (707) 771-5568
LICENSING EVALUATOR SIGNATURE:
DATE: 03/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/25/2024
LIC809 (FAS) - (06/04)
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