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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 490110699
Report Date: 10/08/2019
Date Signed: 10/08/2019 03:20:58 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:FUMC PRESCHOOL CHILD CARE CENTERFACILITY NUMBER:
490110699
ADMINISTRATOR:DIANE WIKSEFACILITY TYPE:
850
ADDRESS:1551 MONTGOMERY DRIVETELEPHONE:
(707) 546-7012
CITY:SANTA ROSASTATE: CAZIP CODE:
95405
CAPACITY:48CENSUS: 25DATE:
10/08/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Diane WikseTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) J. Velasco conducted an unannounced case management inspection re: an Unusual Incident Report (UIR) filed by director Diane Wikse (D1) about a 10/01/2019 incident in which a child (C1) in care was signed out by their parent (A1) and then eloped from the facility and was discovered on the sidewalk by another child's relative (A2). Facility reported the incident to CCLD on 10/02/2019.

During the inspection, LPA observed 25 children receiving care and supervision from six staff. The facility was operating within licensed capacity and ratio requirements. LPA obtained a current roster of children in care and other facility documents, reviewed facility records, and reviewed with D1 the facility's procedures for preventing and responding to elopements. At 1:30 p.m., LPA interviewed three staff (D1, S1, and S2), one adult (A2), and one child (C1). Interviews and document reviews corroborated that C1 was signed out when they eloped from the facility. D1 stated additional staff will remain near the facility exits from the playground to ensure no children can elope during these transition periods. Interviews corroborated that staff took reasonable precautions to ensure children were supervised while in care and took immediate steps to update procedures to ensure children are supervised to prevent elopement even before and after they are signed in and out of care.

No deficiencies were cited during this inspection.
A Notice of Site Visit is 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: 10/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2019
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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