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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 490108746
Report Date: 02/24/2020
Date Signed: 02/24/2020 01:27:51 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME:CHILDREN'S CORNERFACILITY NUMBER:
490108746
ADMINISTRATOR:CICCHETTO, JANFACILITY TYPE:
850
ADDRESS:629 EAST D STREETTELEPHONE:
(707) 763-6191
CITY:PETALUMASTATE: CAZIP CODE:
94952
CAPACITY:100CENSUS: 75DATE:
02/24/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Jan CicchettoTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Jennifer Velasco conducted an unannounced case management inspection re: an Unusual Incident Report (UIR) filed by director Jan Cicchetto (D1) about a 12/17/2019 incident in which at 3:30 p.m. a child (C1) toppled over a low wall and sustained injury. Staff immediately contacted the parents and provided first aid and monitoring to the child. Staff reported the parent (A1) took C1 for dental assessment. At the time of the incident, the facility was operating within ratio, and six staff were providing care to 38 children. Facility reported the incident to CCLD by telephone and fax on 12/18/2019.

During today's inspection, LPA toured the facility, obtained facility documents, observed 12 staff providing care and supervision to 75 children, and interviewed one staff (S1) and the director (D1). C1 was not at the facility today but is still enrolled. No deficiencies were cited during this inspection.

Notice of Site Visit to be posted for 30 days.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Jennifer VelascoTELEPHONE: (707) 588-5044
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2020
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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