493008417-3-11-2020-01-CC-JVEO-BMLNJN-20200311103038

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 493008417
Report Date: 03/11/2020
Date Signed: 03/11/2020 10:30:47 AM

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:	ROSS, SHAELA FCCH		FACILITY NUMBER:	493008417
ADMINISTRATOR:	ROSS, SHAELA & ROBYN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(707) 483-9741
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95405
CAPACITY:	14	CENSUS: 7	DATE:	03/11/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Shaela Ross		TIME COMPLETED:	10:45 AM

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 unannounced inspection of the facility was conducted by Licensing Program Analysts (LPAs) Amy Strother and Jennifer Velasco. The facility file was reviewed prior to this inspection. A review of the personnel report indicated that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Four adults live in the home. The facility’s operating hours are 7:00 am - 6:30 pm, Monday-Friday, year-round. Individual arrangements are occasionally made to operate weekday evenings until 10:00 p.m. and/or Saturdays between 8:00 a.m. - 5:00 p.m. The facility was toured inside and outside, and the floor and yard plan submitted by the licensee were verified. The on limits areas are the preschool room (living room), hall bathroom, hallway, nap room (family room), kitchen, baby room (converted garage), and the playground part of the backyard, which is fully fenced. The off-limits areas are the other, separate part of the backyard, three bedrooms, two bathrooms, the backyard shed. These are rendered inaccessible by way of key locks, doorknob covers, gates, and slide locked doors. The items which could pose a danger to children (such as detergents, cleaning compounds, and medications) were observed to be stored in locked cabinets in the preschool and baby classrooms and above the refrigerator in the kitchen and inaccessible to children. Licensee stated there are no poisons in the facility, and none were observed. The toys, floors, desks, and other equipment and surfaces were clean, toxic free, safe, and in good condition. The children's bathroom was in safe, sanitary, and operable condition. Food prep areas were clean. Food was properly stored and refrigerated as needed. The fully fenced playground was free of hazards. The playground equipment and surface areas were in safe condition. There was pea gravel to provide cushioning underneath climbing structures to absorb falls. There were no swimming pools or other bodies of water observed on the property. Licensee stated no weapons are stored on site and none were observed. Continued on LIC 809-C.

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Jennifer Velasco	TELEPHONE: (707) 588-5044
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2020

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,
, CA

FACILITY NAME: ROSS, SHAELA FCCH	FACILITY NUMBER: 493008417
	VISIT DATE: 03/11/2020

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
26
27
28
29
30
31
32

Continued from LIC 809.

During today's inspection, staffing ratios were being met. Three staff were supervising seven children. The facility was operating within the licensed capacity. At least one staff member present during the inspection possessed current pediatric CPR and First Aid certifications, which expire in 08/2021. Five children’s records were reviewed at 9:40 a.m. and contained immunizations and/or medical exemptions and Parents' Rights forms. Four staff records were reviewed at 10:00 a.m. and contained documentation of education and training as required.

This facility is currently not providing Incidental Medical Services (IMS) to children but plans to after filing an IMS plan with the Department. The facility's Plan of Operation includes information regarding IMS services. The Department’s IMS policy was discussed with the Licensee. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.

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: www.ada.gov/childqanda.htm. This report, as well as the AAP Guide to Safe Sleep Practices and the Lead Exposure brochure, 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.

There were no Title 22 deficiencies cited during today's inspection.

Notice of Site Visit shall be posted for 30 days from today's visit.

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Jennifer Velasco	TELEPHONE: (707) 588-5044
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2020

LIC809 (FAS) - (06/04)

Page: 2 of 2