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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493008341
Report Date: 02/11/2022
Date Signed: 02/11/2022 02:21:44 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:ROSENBAUM, AMY FCCHFACILITY NUMBER:
493008341
ADMINISTRATOR:ROSENBAUM, AMYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 658-2300
CITY:PETALUMASTATE: CAZIP CODE:
94952
CAPACITY:14CENSUS: 0DATE:
02/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Amy RosenbaumTIME COMPLETED:
01:30 PM
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An annual required inspection of the facility was conducted by Licensing Program Analyst, Jennifer Velasco (LPA), who met with Licensee Amy Rosenbaum (L1). 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. 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. L1 provides care in three studios, an indoor bathroom, multiple fully fenced and covered patios and outdoor classrooms, and an upper playground. During today’s inspection the home and grounds were toured. L1 had no children in care for the day. No children were observed left in any parked vehicle. The facility's operating hours are 8:30 a.m. - 2:50 p.m., Monday - Thursday, and some weeks Tuesday - Friday, if there was a Monday holiday. The facility closes briefly during summer break. The floor plan submitted by the licensee was reviewed and verified. The off-limits areas of the home are the upper floor of the main house and the portions of the property beyond the inner fence line. These were made inaccessible by use of key locked doors, combination padlocks, fencing, and secured gates. The facility studios were observed to be clean and orderly and were at a comfortable indoor temperature. There were safe toys and equipment available for children. L1 stated there is a working telephone in the home. L1’s pediatric CPR and First Aid certifications were reviewed and expire in 07/2022. L1 stated there are no poisons at the facility, and none were observed during this inspection. 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 in a high cupboard in each studio. LPA observed a working smoke detector, carbon monoxide detector and fire extinguisher, rated at least 2A10BC, in the home.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Jennifer VelascoTELEPHONE: (707) 588-5044
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2022
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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: ROSENBAUM, AMY FCCH
FACILITY NUMBER: 493008341
VISIT DATE: 02/11/2022
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The roster of children in care was reviewed and was current. L1 documented the most recent emergency drill in 01/2022. L1 stated there are no firearms or other weapons in the home, and none were observed. The staircase was barricaded. Children's records were reviewed at 12:00 p.m., and files contained current immunizations and/or medical exemptions, as well as Parents' Rights Notifications, as required. Facility and staff files were reviewed and contained required documentation. LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed L1 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. 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. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with L1. There were no Title 22 deficiencies cited during today's inspection. To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov . For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing-process
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Jennifer VelascoTELEPHONE: (707) 588-5044
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2022
LIC809 (FAS) - (06/04)
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