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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493007229
Report Date: 01/14/2025
Date Signed: 01/14/2025 02:38:12 PM

Document Has Been Signed on 01/14/2025 02:38 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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:KERSTON, SHANNON FCCHFACILITY NUMBER:
493007229
ADMINISTRATOR/
DIRECTOR:
KERSTON, SHANNONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 588-9332
CITY:ROHNERT PARKSTATE: CAZIP CODE:
94928
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
01/14/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:27 PM
MET WITH:Shannon KerstonTIME VISIT/
INSPECTION COMPLETED:
02:28 PM
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An unannounced visit was made to the facility today by Licensing Program Analyst (LPA) Y. Yang. A review of staff records on 01/14/2025 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. 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. There are currently two adults living in the home.

During today’s inspection the home and grounds were toured. There were no daycare children in attendance during today's visit. The facility’s operating hours are 07:30am to 04:00pm, Mon through Thur. The floor plan submitted by the licensee was reviewed and verified. The off-limits areas of the home were made inaccessible by door locks and/or child gates. The home was at a comfortable indoor temperature. There were safe toys and equipment available for children. The home's fireplace is covered by barricade. The licensee stated there is a working telephone in the home. The licensee’s pediatric CPR and First Aid and CA mandated reporter training certificate were reviewed and expire September 2026 and September 2025, respectively. 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 fire extinguisher, rated at least 2A10BC, in the home. The licensee stated that poisons, firearms, and ammunition are not stored on the premises. The home's backyard is fully fenced and on limits. There is an above ground pool located in the home's backyard. The pool fencing meets regulations and has a self latching and self closing gate that swings away from the pool. During today's visit, the LPA provided technical assistance regarding the new AB2866 pool safety regulations. Five children's records were reviewed during today's inspection. Children's immunization records, identification and emergency forms, and notification of parent's rights forms were on file. The LPA reviewed completed infant 15 minute sleep check logs and infant safe sleep plans. One staff file was reviewed during the inspection and contained the documents as specified on the inspection checklist. Continued on LIC 809-C
Megan AvilesTELEPHONE: (530) -89-5033
Yang YangTELEPHONE: 707-588-5026
DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/14/2025
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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: KERSTON, SHANNON FCCH
FACILITY NUMBER: 493007229
VISIT DATE: 01/14/2025
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The LPA provided the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as a resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

The Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.



Incidental Medical Services (IMS) policy was discussed. 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 (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

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee, Shannon Kerston. There were no Title 22 regulations cited during today's inspection. During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) -89-5033
LICENSING EVALUATOR NAME: Yang YangTELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2025
LIC809 (FAS) - (06/04)
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