490170978-2-7-2020-01-CC-JVEO-BLKT5Z-20200207132621

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 490170978
Report Date: 02/07/2020
Date Signed: 02/07/2020 01:26:26 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:	VOGT, JODY FAMILY CHILD CARE HOME		FACILITY NUMBER:	490170978
ADMINISTRATOR:	VOGT, JODY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(707) 578-0549
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95405
CAPACITY:	14	CENSUS: 12	DATE:	02/07/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Jody Vogt		TIME COMPLETED:	01:30 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 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 an assistant were supervising twelve 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 7:00 a.m. - 5:30 p.m., Monday through Thursday and 7:00 a.m. - 5:00 p.m. on Friday . Services are provided year-round. The floor plan submitted by the licensee was reviewed and verified. The off-limits areas of the home are the utility closets, side yards and sheds. These were made inaccessible by use of key locked doors and 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 pediatric CPR and First Aid certifications were reviewed and expire in 11/2020. 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 high cupboard in the kitchen. Licensee stated and LPA verified that poisons are inaccessible in a locked shed in the backyard. 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)

Page: 1 of 2

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: VOGT, JODY FAMILY CHILD CARE HOME	FACILITY NUMBER: 490170978
	VISIT DATE: 02/07/2020

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
26
27
28
29
30
31
32

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 12/2019. 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 in the backyard. Six children's records were reviewed at 12:00 p.m., and files contained current immunizations and/or medical exemptions, as well as Parents' Rights Notifications, as required. Facility files were reviewed at 12:30 p.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)

Page: 2 of 2