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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483009843
Report Date: 12/02/2019
Date Signed: 12/02/2019 02:58:51 PM

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:SCRIBNER, CLAIRE FCCHFACILITY NUMBER:
483009843
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
12/02/2019
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Claire ScribnerTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Glenn Ouye arrived to conduct a change of location pre-licensing inspection. The licensee is requesting a change of location for a small Family Child Care Home.

Child care services will be provided Monday through Friday from 7:45 am to 6:00pm. The licensee understands that providing 24 hour consecutive care is prohibited. The residence is a two story, two bedroom / 2 bathroom home. There is one adult 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. The entire downstairs is used as the day care area. There is a bathroom for the children in care. The upstairs of the home is off limits and made inaccessible with a child safety gate. There is no fireplace in the home. The staircase is made inaccessible with a child safety gate. Items such as medications, disinfectants and medications are inaccessible to children. There are no poisons stored in the home, but the facility has a lockable storage where poisons can be stored. There are no firearms or dangerous weapons at the facility. The back yard is completely fenced and will be used for outdoor play. There are no pools or other bodies of water at the facility. 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 children in care will have access to age appropriate toys and equipment.
The home is equipped with a working smoke detector/carbon monoxide detector combination and a charged fire extinguisher rated above the minimum 2A 10-BC.

1. The licensee agrees to install outlet covers on all electrical outlets that are at an accessible level to children.
2. The licensee agrees to clean up the outdoor area with all construction debris.
3. The licensee agrees to install lattice on the side of the staircase leading to the second story deck. The licensee has a child safety gate at the bottom of the stairs.

The licensee agrees to provide evidence of completing of the three requirements to CCL. When evidence is provided, the facility is ready for licensure.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Glenn OuyeTELEPHONE: (707) 588-5042
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2019
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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