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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493006475
Report Date: 09/10/2020
Date Signed: 02/16/2021 04:58:43 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:CARRILLO, LETICIA FCCHFACILITY NUMBER:
493006475
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 1DATE:
09/10/2020
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
06:00 PM
MET WITH:Leticia CarrilloTIME COMPLETED:
06:30 PM
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Licensing Program Analyst (LPA) Leticia Rosales-Meza conducted a Zoom video conference Tele-Inspection Case Management with Leticia Carrillo, Licensee in response to an increase capacity application received by the Department on 07/06/20. The licensee is requesting a capacity of 14. Due to COVID-19, the Department has suspended all field operations, and the Licensee has agreed to meet with LPA via video conference. On 08/07/20, the Sonoma County Fire Marshal granted the facility a fire clearance to operate at a capacity of 14. A review of staff records on 09/10/20 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 are currently three adults living in the home.

During the Tele-Inspection, the licensee provided a virtual tour of the facility’s on limits areas and backyard. The day care space is the living room, dining room, kitchen, family room, downstairs bedroom, and downstairs bathroom. The off-limits areas of the home are the second story of the home and garage, and were made inaccessible by a chain lock on top door to the garage and a secured gate is located at bottom of stairs. The facility’s operating hours are 6:00 AM to 7:00 PM, Monday - Sunday. The floor plan submitted by the licensee was reviewed and verified. Electrical outlets are covered and drapery cords are not accessible. The children's bathroom is free of toxins. There is a working telephone in the home. Items which could pose a danger to children (detergents, cleaning compounds, and medications) were stored out of the reach of children. There is a working smoke detector, carbon monoxide detector and fire extinguisher in the home. The licensee has a current roster of children in care and has conducted an emergency drill within the past six months. The licensee stated there are no firearms and/or other dangerous weapons in the home, and none were observed during today's Tele-Inspection. The children use the backyard as the outdoor play area and it is fully fenced. There are no bodies of water on the property. Pediatric CPR and Pediatric First Aid cards expire on 08/2022 for Licensee, and for assistant. All licensing reports are public information and must be made available upon request for at least three years.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Leticia RosalesTELEPHONE: (707) 588-5061
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2020
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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME: CARRILLO, LETICIA FCCH
FACILITY NUMBER: 493006475
VISIT DATE: 09/10/2020
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The Licensee's signature was not recorded on this Facility Evaluation Report (LIC 809 & LIC 809-C), however, the Licensee was provided with a copy of this report; and the Licensee's proof of Read Receipt is on file. LPA also mailed a copy of this report to the Licensee.


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


The increase capacity to 14, as a Large Family Child Care Home is granted as of today, 9/10/20.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Leticia RosalesTELEPHONE: (707) 588-5061
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2020
LIC809 (FAS) - (06/04)
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