493003079-10-7-2019-01-CC-JVEO-BGQPT9-20191007113534

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 493003079
Report Date: 10/07/2019
Date Signed: 10/07/2019 11:35:42 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:	FINKE, STACY FAMILY CHILD CARE HOME		FACILITY NUMBER:	493003079
ADMINISTRATOR:	FINKE, STACY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(707) 888-3070
CITY:	BODEGA	STATE: CA	ZIP CODE:	94922
CAPACITY:	14	CENSUS: 11	DATE:	10/07/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Stacy Finke11		TIME COMPLETED:	11:45 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) J. 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 is currently one adult living in the home. During today’s inspection the home and grounds were toured. The licensee and one assistant were supervising 11 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 8:30 a.m. - 3:30 p.m., Monday - Thursday; 8:30 a.m. - 3:00 p.m., Friday. The off-limits areas of the home are the the master suite, the woodshed area, the fenced area north of the home near the side of the property, the storage closets in the home, and the barn in the front of the home. These were made inaccessible by use of key locked doors, fencing, 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 and staffs' pediatric CPR and First Aid certifications were reviewed and expired. 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 inaccessible kitchen of the main home. Licensee stated and LPA verified that there are no poisons in the home. There is a tributary north of the home. In the event of heavy rains, it may be possible for the tributary to contain a large body of water. The tributary is barricaded with a fence that meets regulation standards for rendering a body of water inaccessible to children in care. 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: 10/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2019

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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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: FINKE, STACY FAMILY CHILD CARE HOME	FACILITY NUMBER: 493003079
	VISIT DATE: 10/07/2019

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 08/2019. The licensee stated there are no firearms or other weapons in the home, and none were observed during this inspection. Children use the fully fenced, partially shaded backyard as an outdoor play space. Five children's records were reviewed at 10:00 a.m., and files contained current immunizations and/or medical exemptions, as well as Parents' Rights Notifications, as required. Facility files were reviewed at 10:30 a.m., and licensee and staff CPR/First Aid certifications were expired.

The licensee is NOT currently Incidental Medical Services (IMS) to children in care. Licensee plans to provide the Department with a Plan of Operation. 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.

The following violation(s) of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Appeal Rights were provided.

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Jennifer Velasco	TELEPHONE: (707) 588-5044
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2019

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: FINKE, STACY FAMILY CHILD CARE HOME	FACILITY NUMBER: 493003079
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/07/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/25/2019 Section Cited	1 2 3 4 5 6 7	Personnel Requirements. The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by:
	8 9 10 11 12 13 14	LPA reviewed facility files and saw the Licensee's pediatric CPR and First Aid certifications were msising. Licensee stated they were expired. This poses a potential health and safety risk to the children in care.	8 9 10 11 12 13 14	email: jennifer.velasco@dss.ca.gov fax 707-588-5099
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Jennifer Velasco	TELEPHONE: (707) 588-5044
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2019

LIC809 (FAS) - (06/04)

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