490170168-2-7-2020-01-CC-JVEO-BLKQ3G-20200207104843

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 490170168
Report Date: 02/07/2020
Date Signed: 02/07/2020 10:48:50 AM

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:	CARLSON, DEBORAH FAMILY CHILD CARE HOME		FACILITY NUMBER:	490170168
ADMINISTRATOR:	CARLSON, DEBORAH		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(707) 573-3703
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95405
CAPACITY:	14	CENSUS: 9	DATE:	02/07/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:10 AM
MET WITH:	Deborah Carlson		TIME COMPLETED:	11:00 AM

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 inspection of the facility was conducted by Licensing Program Analyst (LPA) Jennifer Velasco. A review of staff records prior to this inspection indicates that all facility staff and other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. There are currently two adults living in the home. During today’s inspection the home and grounds were toured. The licensee and two assistants were supervising nine children under ten years of age and operating within the licensed capacity and ratio requirements. No children were observed left in any parked vehicle. The facility’s operating hours are 7:30 a.m. - 5:00 p.m., Monday - Friday, year-round. The floor plan submitted by the licensee was reviewed and verified. Care is provided in the converted garage, hall bathroom, and fenced side yard. Occasionally, care is provided in the kitchen/family room area. The off-limits areas of the home are the bedrooms, master bathroom, office, formal living room, backyard, enclosed deck, and two inaccessible storage sheds. These were made inaccessible by use of key and combination locked doors, fencing, and padlocked gates. 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 and staffs' pediatric CPR and First Aid certifications were reviewed and expire in 09/2021. 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 in a locked cupboard in the kitchen. Licensee stated and LPA verified that poisons are inaccessible in a key locked shed in the inaccessible portion of the yard. Continued on LIC 809-C.

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Jennifer Velasco	TELEPHONE: (707) 588-5044
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2020

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: CARLSON, DEBORAH FAMILY CHILD CARE HOME	FACILITY NUMBER: 490170168
	VISIT DATE: 02/07/2020

NARRATIVE

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Continued from LIC 809.

LPA observed a working smoke detector, carbon monoxide detector and fire extinguisher, rated at least 2A10BC, in the home. The roster of children in care was reviewed and was current. The licensee has conducted an emergency drill within the past six months; the last drill was documented in 01/2020. The licensee stated there are no firearms or other weapons in the home, and none were observed during this inspection. There were no pools or other bodies of water. Children use the fully fenced, partially shaded side yard as an outdoor play space. Five children's records were reviewed at 9:20 a.m., and files contained current immunizations and/or medical exemptions, as well as Parents' Rights Notifications, as required. Facility files were reviewed at 9:45 a.m., and licensee and staff immunization and certification records were on file as required.

The licensee is not currently providing Incidental Medical Services (IMS) to children in care. The 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, a Plan for Providing IMS must be submitted to the Department.

The following information regarding ADA was provided: US Department of Justice toll-free ADA Information 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 The Effects of Lead Exposure brochures, were reviewed and discussed with the licensee. All licensing reports are public information and must be made available upon request for at least three years.

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: Jennifer Velasco	TELEPHONE: (707) 588-5044
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2020

LIC809 (FAS) - (06/04)

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