493010038-4-16-2021-01-CC-ASTR-C25RG5-20210416130009

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 493010038
Report Date: 04/16/2021
Date Signed: 04/16/2021 01:00:16 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:	EL, SHELDON FCCH		FACILITY NUMBER:	493010038
ADMINISTRATOR:	EL, SHELDON		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 717-0627
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95404
CAPACITY:	14	CENSUS: 0	DATE:	04/16/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Sheldon El		TIME COMPLETED:	11:30 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	A change of location pre-licensing inspection was conducted via tele-inspection due to the COVID-19 pandemic by Licensing Program Analyst (LPA) Amy Strother. The applicant submitted an application on February 10, 2021 requesting to be licensed at the new address due to a change of location. The licensee was previously licensed at facility number #493009833 . The licensee is requesting a license for a capacity of 14 children. Fire Clearance was received by the Department on 04/06/21. Services will be available Monday - Friday, 7:30 AM – 6:00 PM. The licensee understands that 24hr consecutive care is prohibited. The residence is a two story, 6 bedroom, 3.5 bathroom home. There is one adult living in the home. The licensee was advised that all adults residing or working at the facility must have a criminal background clearance on file with CCLD. The licensee is aware of the immediate $100 per day civil penalty for adults working or residing in the home without a criminal record clearance. The floor and yard plans are verified. The children will have access to the lower level of the home to include the living room, dining room, kitchen, two bedrooms and two bathrooms. The upstairs is made inaccessible with a gate at the bottom of the stairs. There is a neighboring studio which has its own physical address and is not accessible from inside of the child care home. The home appears to be clean and orderly at this time and will remain so during child care hours. The licensee uses a cell phone as the facility telephone in the home. The sharp knives, cleaning supplies, medicines, are inaccessible to children, located in a locked kitchen cabinet, out of reach of children. The applicant does not have firearms in the home. The applicant has been advised that poisons are to be locked with either key lock or combination lock. The applicant stated that she does not have poisons on the premises. The children in care will have access to age appropriate toys and equipment, located in the playroom to the left of the front door. The children will nap in the bedroom to the right of the front door. LPA discussed new Safe Sleep regulations, and the requirements for form LIC9227 and visual checks every 15 minutes to be logged on a sleep log. The home is equipped with a working smoke detector, carbon monoxide detector and fire extinguisher rated at least 2A10BC. There is a central heating/cooling unit. The facility family room has a gas fireplace which is enclosed and the licensee stated will not be used during child care hours. Continue on LIC809-C

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy Strother	TELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:	DATE: 04/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2021

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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: EL, SHELDON FCCH	FACILITY NUMBER: 493010038
	VISIT DATE: 04/16/2021

NARRATIVE

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The children will use the backyard as the outdoor play area. The backyard is completely fenced. The backyard has a large deck with 6 steps going down to the ground level. LPA informed applicant of the requirement to add a child safety gate at the top and bottom of the staircase per regulation. The is currently a fire pit in the backyard. Applicant stated that the fire pit will remain free of wood debris and ash and will not be used during child care hours. There is no trampoline on the premises. There is no pool, spa, pond, fountain, nor any other source of water accessible to the children, and none is to be added without prior notification and approval of the licensing agency. There are no bodies of water on the facility. Any proposed changes to the physical plant, telephone number, or change of address shall be immediately reported to the Department.

Incidental Medical Services regulations were reviewed with the licensee. The licensee understands that if Incidental Medical Services are provided, an updated Plan of Operation shall be submitted and on file with the Department.

Parents will be required to sign insurance affidavits if the provider does not plan to purchase additional child care liability insurance. Proof of control of property or landlord notification is on file. Parent's rights are posted. Emergency drills must be conducted at least once every six months and the date documented. Children's records to be maintained were reviewed. The roster is to remain current at all times. Unusual Incident Report procedures were explained, to include notification before close of next business day and follow-up with written report within seven days. The licensee will maintain current pediatric CPR, First Aid, and child abuse mandated reporter training certification. The licensee shall be present in the home and shall ensure that children in care are supervised by a fingerprinted adult with current pediatric CPR and First Aid certification. The licensee understands that children may only be transported by adults with a criminal record clearance and are never to be left unattended in a vehicle. Infants and children shall not be allowed to sleep in car carriers in the home. The licensee clearly understands the maximum number of children for whom care can be provided and the limitations on the number of infants (birth to age 2) that may be cared for and when two of the children in care must be school aged. Smoking is prohibited at all times in any area where child care is provided. The licensee understands the responsibility to read and have knowledge of the laws and regulations for operation of a family child care home. Forms and regulations must be obtained from the website http://ccld.ca.gov/. The licensee understands that any authorized employee of the Department may enter and inspect the facility with or without advance notice. Any proposed changes to the physical plant, telephone number, or change of address shall be immediately reported to the Department.

The approval of license is pending the following item:
1. Proof that the top and bottom of stairs of deck to backyard are barricaded.

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy Strother	TELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:	DATE: 04/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2021

LIC809 (FAS) - (06/04)

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