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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493007243
Report Date: 02/28/2020
Date Signed: 02/28/2020 01:38:49 PM

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:LITTLE ANGELS CHILDREN'S CENTERFACILITY NUMBER:
493007243
ADMINISTRATOR:TAMBLIN, KRISTINFACILITY TYPE:
850
ADDRESS:4305 HOEN AVENUETELEPHONE:
(707) 579-4305
CITY:SANTA ROSASTATE: CAZIP CODE:
95405
CAPACITY:36CENSUS: 17DATE:
02/28/2020
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Kristin TamblinTIME COMPLETED:
01:45 PM
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LPA conducted an unannounced Case Management inspection at the request of the director (D1), regarding the termination of services to a child (C1). The termination was reported to Community Care Licensing on 02/21/2020. During today's inspection, LPA toured the facility, reviewed facility documents, and observed three staff providing care and supervision to 17 children. LPA interviewed three staff (S1-S3) and D1.

During today's inspection, D1 stated facility staff developed and implemented a plan to prevent the termination of services to C1 and provided training on how to implement this plan with all staff. The plan included preparing for interactions with the parent (A1) by focusing on the care and needs of C1, ensuring particularly complete and detailed documentation of all information re: the care and needs of C1 and the other children in care, and providing A1 with consultation on the need for facility staff to provide for the needs of all children in care, including C1. LPA provided consultation to D1 on documentation processes and managing the expectations of the authorized representatives of children in care. Based on information available at this time, it does not appear that the termination constituted a deficiency of Title 22 regulations.

Notice of Site Visit to be posted for 30 days.

No Title 22 deficiencies were cited during today's inspection.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Jennifer VelascoTELEPHONE: (707) 588-5044
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2020
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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