<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493007136
Report Date: 07/17/2019
Date Signed: 07/17/2019 09:35:13 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:ROSE, CAMILLA FCCHFACILITY NUMBER:
493007136
ADMINISTRATOR:ROSE, CAMILLAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 938-3454
CITY:SONOMASTATE: CAZIP CODE:
95476
CAPACITY:14CENSUS: 0DATE:
07/17/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:TIME COMPLETED:
09:50 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 annual inspection was made to the facility by Licensing Program Analyst (LPA) Kevin O'Connell. A review of staff records on 7/17/19 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 2 adults living in the home. During today’s inspection the home and grounds were toured with the licensee at 08:40am.
Operating hours are 7:30am to 5:30pm, Mon–Fri. Today there were 7 preschool children, Licensee and an assistant.
Primary care areas are the kitchen, dining room, child care room, 3 bedrooms (for sleeping only) and the hall bathroom. The master bath has a slide bolt and the detached garaged is key locked.
The back yard is fully fenced and used for outdoor play. The fireplace was screened. Poisons are key locked in the back yard detached garage. 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. There is a working telephone in the home. 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. The LPA observed a working smoke detector, carbon monoxide detector and a charged fire extinguisher rated at least 2A:10-BC, in the home. The roster of children in care was reviewed and was current and a fire disaster drill was conducted within the past six months (6/19).
Licensee and assistant had current Pediatric CPR and First Aid certifications.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Kevin O'ConnellTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2019
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: ROSE, CAMILLA FCCH
FACILITY NUMBER: 493007136
VISIT DATE: 07/17/2019
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
Licensee stated that there were no guns, dangerous weapons or bodies of water on the premises and none were observed.
Five children's records was reviewed at 08:50am for Immunizations and signed Notification of Parent’s Rights forms and all were complete. Two staff files were reviewed (at 09:00am) for immunizations and Mandated Reporter Training certificates and all were complete.
This facility provides Incidental Medical Services – IMS (Inhaler). LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. The following information regarding ADA was provided: US Department of Justice (USDOJ) 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, available at: http:/www.ada.gov/childqanda.htm

This report, as well as the AAP Guide to Safe Sleep, Safe Sleep in Childcare brochure, What does a Safe Sleep Environment Look Like brochure & Safe Sleep Concepts handout, were reviewed and discussed with the licensee. The Effects of Lead Exposure brochure has been reviewed with 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.
Failure to keep this notice posted for 30 days may result in a civil penalty of $100.
No deficiencies were cited today.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Kevin O'ConnellTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2