483009970-8-31-2021-01-CC-YYAG-C6ENU4-20210831104544

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 483009970
Report Date: 08/30/2021
Date Signed: 08/31/2021 10:46:12 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:	WYNN, SHARON FCCH		FACILITY NUMBER:	483009970
ADMINISTRATOR:	WYNN, SHARON		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(707) 862-9500
CITY:	FAIRFIELD	STATE: CA	ZIP CODE:	94533
CAPACITY:	14	CENSUS: 0	DATE:	08/30/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:44 AM
MET WITH:	Sharon Wynn		TIME COMPLETED:	12:25 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	An unannounced annual required inspection was made to the facility by Licensing Program Analyst (LPA), Y. Yang. A review of staff records on 08/30/2021 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. There is currently one adult living in the home. During today’s inspection the home and grounds were toured. There were no children present at the facility. The facility’s operating hours are 08:30am to 04:00pm, Monday-Friday. The floor plan submitted by the licensee was reviewed and verified. Four bedrooms and two baths on the upper level, laundry room and garage are off limits to the children. They were made inaccessible by child gates and/or door knob covers and latches. The home was observed to be clean and orderly, and was at a comfortable indoor temperature. There were safe toys and equipment available for children. The licensee stated there is a working telephone in the home. The licensee’s pediatric CPR and First Aid certification was reviewed and expire in August 2022. The licensee's CA Child Abuse Mandated Reporter training certificate expires June 2023. Items which could pose a danger to children (such as detergents, cleaning compounds, medications, etc.) were observed to be stored out of the reach of children. The licensee stated that poisons, firearms, and ammunition are not stored on the premises. The LPA observed a working smoke detector, carbon monoxide detector and fire extinguisher, rated at least 2A10BC, in the home. The fireplace in the living room is barricaded. The roster of children in care was reviewed and was current. The children use the home’s backyard as the outdoor play area. It is fully fenced and there were no bodies of water observed. No children's records were reviewed today. The licensee currently does not have any children enrolled at her program. Infant safe sleep check logs and the infant safe sleep plan were discussed with the licensee. Continued on LIC 809-C

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Yang Yang	TELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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: WYNN, SHARON FCCH	FACILITY NUMBER: 483009970
	VISIT DATE: 08/30/2021

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The licensee currently does not have any children in care requiring Incidental Medical Services (IMS). The Department's Incidental Medical Services (IMS) policy was discussed with the licensee. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, an IMS plan of operation must be submitted to the Department.

The following information regarding ADA was provided: US Department of Justice toll-free ADA Line at (800) 514-0301 (voice)/(800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, www.ada.gov/childqanda.htm. This report, as well as the AAP Guide to Safe Sleep Practices and COVID guidelines and best practices, and infant safe sleep regulations and best practices were reviewed and discussed with the licensee.

Notice of Site Visit shall be posted for 30 days from today's visit.

There were no Title 22 deficiencies cited during today's inspection.

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Yang Yang	TELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2021

LIC809 (FAS) - (06/04)

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