493007238-9-3-2019-01-CC-ASTR-BFNQTM-20190903122723

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 493007238
Report Date: 09/03/2019
Date Signed: 09/03/2019 12:27:36 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:	CHADWICK, DEBRA FCCH		FACILITY NUMBER:	493007238
ADMINISTRATOR:	CHADWICK, DEBRA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(707) 544-7244
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95401
CAPACITY:	14	CENSUS: 7	DATE:	09/03/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Debra Chadwick		TIME COMPLETED:	12:45 PM

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 random inspection was made to the facility by Licensing Program Analyst (LPA), Amy Strother. 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 are currently four adults living in the home. During today’s inspection the home and grounds were toured. The licensee and two assistants were supervising 7 children, and operating within the licensed capacity and ratio requirements. No children were observed left in any parked vehicle. The facility’s operating hours are 6:30 a.m. to 5:30 p.m., Monday–Friday. The floor plan submitted by the licensee was reviewed and verified. The off-limits areas of the home are the entire upstairs and the downstairs bedroom, and were made inaccessible by child safety gates. 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. The licensee stated there is a working telephone in the home. The licensee’s pediatric CPR and First Aid certifications were reviewed, and expired on July 2019. The licensee stated at 10:05 a.m. that her and her assistants, Staff 1 and Staff 2 (S1 & S2) CPR and First Aid certifications have expired and that she left a voicemail for the person that usually conducts the class that they take but has not yet heard back. 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. Licensee stated that no poisons are stored on the premises and none were observed during today's inspection. The staircase in the entryway of the home was barricaded with a child safety gate. The fireplace has been made inaccessible with a piece of furniture in the livingroom. Licensee stated that the fireplace is no longer used. The LPA observed a working smoke detector, carbon monoxide detector and fire extinguisher, rated at least 2A10BC, in the home. The roster of children in care was reviewed and was current. The licensee has conducted an emergency drill within the past six months, last drill was documented 9/2019. The licensee stated there are trap-shooting guns locked in a off-limits bedroom. Licensee stated that there is no ammunition in the home. Continue on 809-C

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy Strother	TELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:	DATE: 09/03/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2019

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: CHADWICK, DEBRA FCCH	FACILITY NUMBER: 493007238
	VISIT DATE: 09/03/2019

NARRATIVE

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The children use the backyard as the outdoor play area and it is fully fenced. There were no pools or other bodies of water observed. Four children's records were reviewed at 10:30 a.m.; current immunizations and Notification of Parent’s Rights forms were on file. The licensee is not currently providing Incidental Medical Services (IMS) to children in care. The Incidental Medical Services (IMS) policy was discussed with the licensee. 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 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, www.ada.gov/childqanda.htm. This report, as well as the AAP Guide to Safe Sleep Practices and The Effects of Lead Exposure brochures, were reviewed 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.

The following violation(s) of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Appeal Rights were provided.

An exit interview was conducted and Plans of corrections were reviewed and developed with the Licensee. Appeal Rights were provided and discussed with, Debra Chadwick whose signature on this form confirm receipt of these documents.

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy Strother	TELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:	DATE: 09/03/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2019

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: CHADWICK, DEBRA FCCH	FACILITY NUMBER: 493007238
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/03/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/03/2019 Section Cited	1 2 3 4 5 6 7	102416(c) Personnel Requirements. The Licensee and other personnel as specified shall complete training on preventive health practices including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.
	8 9 10 11 12 13 14	Based on interview and record review, the licensee and assistants (S1 & S2) failed to stay current on her Pediatric First Aid/CPR training. Licensee's and Assistants (S1 & S2) Pediatric First Aid/CPR training certificate expired on 07/2019.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy Strother	TELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:	DATE: 09/03/2019

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2019

LIC809 (FAS) - (06/04)

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