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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493007229
Report Date: 06/11/2021
Date Signed: 06/11/2021 09:06:51 AM

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:KERSTON, SHANNON FCCHFACILITY NUMBER:
493007229
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
06/11/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Shannon KerstonTIME COMPLETED:
09:10 AM
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Licensing Program Analyst (LPA) Glenn Ouye met with Shannon Kerston to conduct a capacity increased case management visit.

The smoke detectors and carbon monoxide detectors were tested and functional. LPA verified the fire extinguisher which is rated at 3A40BC. The licensee conducts emergency disaster drills every six months and has the disaster drills documented.

The licensee is aware of the child ratio for a large FCCH.

The licensee is approved as a large family child care home effective June 11, 2021.

No deficiencies during visit.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Glenn OuyeTELEPHONE: (707) 588-5042
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2021
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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