493009303-5-1-2019-01-CC-JVEO-BBRSJU-20190501135544

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 493009303
Report Date: 05/01/2019
Date Signed: 05/01/2019 01:55:50 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:	SUTTLE, DOREEN FCCH		FACILITY NUMBER:	493009303
ADMINISTRATOR:	SUTTLE, DOREEN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(707) 364-5307
CITY:	PETALUMA	STATE: CA	ZIP CODE:	94954
CAPACITY:	14	CENSUS: 6	DATE:	05/01/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Doreen Suttle		TIME COMPLETED:	02:13 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 unannounced inspection of the facility was conducted by Licensing Program Analyst (LPA) J. Velasco. A review of staff records prior to this inspection indicates that all facility staff and other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. There is currently one adult living in the home. During today’s inspection the home and grounds were toured. The licensee was supervising six 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 7:00 am - 5:30 pm, Monday through Friday, year round. The floor plan submitted by the licensee was reviewed and verified. The off-limits areas of the home are the master bathroom, side yards, and garage. These were made inaccessible by use of key locked doors, gates, and doorknob locks. 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 in 10/2020. Items which could pose a danger to children (such as detergents, cleaning compounds, medications, etc.) were stored out of the reach of children in the upper cupboard in the garage. Licensee stated there were no poisons in the facility, and none were observed during this inspection. There is no fireplace or wood stove in the home. 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. 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: 05/01/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2019

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,
, CA

FACILITY NAME: SUTTLE, DOREEN FCCH	FACILITY NUMBER: 493009303
	VISIT DATE: 05/01/2019

NARRATIVE

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Continued from LIC 809

The licensee has conducted an emergency drill within the past six months; the last drill was documented in 01/2019. The licensee stated there are no firearms the home, and none were observed during this inspection. The children use the yard as the outdoor play area. The yard is fully fenced. There were no pools or other bodies of water. Five children's records were reviewed at 1:00 pm; current immunizations and/or medical exemptions and Notification of Parent’s Rights forms were on file. Facility files were reviewed at 1:20 pm; licensee and staff immunization and certification records 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 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. Licensee is aware of the need to follow safe sleep practices. 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 Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Jennifer Velasco	TELEPHONE: (707) 588-5044
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2019

LIC809 (FAS) - (06/04)

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