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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493005385
Report Date: 09/19/2022
Date Signed: 09/19/2022 04:49:30 PM


Document Has Been Signed on 09/19/2022 04:49 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:BETTER-STEFANSKI, MARGARITA FCCHFACILITY NUMBER:
493005385
ADMINISTRATOR:BETTER-STEFANSKI, MARGARITFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 579-5877
CITY:SANTA ROSASTATE: CAZIP CODE:
95404
CAPACITY:14CENSUS: 10DATE:
09/19/2022
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Margarita Better-StefanskiTIME COMPLETED:
04:55 PM
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A required inspection visit was made to the facility by Licensing Program Analyst (LPA) Leticia Rosales-Meza. LPA met with Licensee, Margarita. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. There is presently four adults living in the home. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

During today’s inspection the Licensee and an assistant were supervising 10 children, operating within the licensed capacity and ratio requirements. There were three infants and seven preschool age children. Licensee provided a current roster of children in care as required. LPA reviewed sleep logs for the infants in care, sleep logs included child’s name, date and time of each 15-minute check as required. A review of the file for the one infant enrolled who is under the age of 12 months, included the required form, LIC 9227 Individual Sleep Plan as required. A review of children’s files revealed that Licensee has an emergency information card (LIC700) and an updated and complete CDPH 286 (blue card) documenting each child's immunization's maintained for each child in care. A review of facility records revealed that Licensee's and assistant's Pediatric First Aid/CPR certificate on file was current and expires 04/2023. The licensee's CA mandated reporter training certificate expires May 2023. Licensee's assistant's CA mandated reporter training certificate expires May 2024.

There were no Title 22 deficiencies cited during today's inspection.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Licensee, Margarita Better-Stefanski.

SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Leticia RosalesTELEPHONE: (707) 588-5061
LICENSING EVALUATOR SIGNATURE:
DATE: 09/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2022
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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