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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493008760
Report Date: 10/04/2019
Date Signed: 10/04/2019 04:02:55 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:HOMEM, BRITNY FCCHFACILITY NUMBER:
493008760
ADMINISTRATOR:HOMEM, BRITNYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 529-7644
CITY:SANTA ROSASTATE: CAZIP CODE:
95401
CAPACITY:14CENSUS: 9DATE:
10/04/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:08 PM
MET WITH:Sierra Gonsalves and Britny HomemTIME COMPLETED:
04:17 PM
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An 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 two adults living in the home.

During today’s inspection the home and grounds were toured. When LPA arrived two assistants were supervising 9 children, and operating within the licensed capacity and ratio requirements. No children were observed left in any parked vehicle. Fifteen minutes into the inspection the Licensee arrived, conducted the tour of the home and provided LPA with the files requested. The Licensee then left the home to attend a medical appointment. The facility’s operating hours are Tuesday, Thursday and Friday 8:00am - 5:30pm. The floor plan submitted by the licensee was reviewed and verified. The off-limits areas of the home are the office downstairs, the garage and the entire upstairs, and were made inaccessible by a child safety gate and locked doors. 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 expire on 08/2021. Assistant, Staff 1 (S1) had a certificate from American Academy of CPR & First Aid, Inc. for Adult CPR/First Aid on file, and expires 10/29/2020. LPA reviewed the requirement with both the Licensee and S1 for the training to be an in-person, pediatric CPR/First Aid training. Licensee stated that she will enroll S1 in the required course, email confirmation of enrollment and provide a certificate to LPA once completed. 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 in the home and none were observed during today's inspection. The staircase in the entry of the home was barricaded with a child safety gate. The fireplace is an enclosed gas fire place, the Licensee stated that is it currently broken and never used during child care hours.
Continue on LIC809-C
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy StrotherTELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2019
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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME: HOMEM, BRITNY FCCH
FACILITY NUMBER: 493008760
VISIT DATE: 10/04/2019
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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 on 07/05/19. The licensee stated there are no firearms and/or other dangerous weapons in the home and none were observed during today's inspection. The children use the backyard as the outdoor play area and it is fully fenced. There is an in ground pool in the backyard. The pool has a five foot fence with a self-closing self latching gate with a fence that does not obstruct the view of the pool, but the fence does not completely surround the pool to meet regulations. A waiver was granted from the above requirement to allow the use of a window locks as the kitchen window opens directly into the fenced pool yard. This window has a rail lock that prevents the window from opening more than 4 inches. The terms of the waiver are being met. Nine children's records were reviewed at 2:40pm; Notification of Parent’s Rights forms were on file. The licensee is not providing Incidental Medical Services (IMS) to children in care. The Incidental Medical Services (IMS) policy was discussed with the assistant. 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 brochure, were reviewed and discussed with the assistant. 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.

There were no Title 22 deficiencies cited during today's inspection.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy StrotherTELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2