493010038-9-15-2021-01-CC-ASTR-C6VMJF-20210915093904

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 493010038
Report Date: 09/07/2021
Date Signed: 09/15/2021 09:40:07 AM

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:	(707) 708-8676
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95404
CAPACITY:	14	CENSUS: 13	DATE:	09/07/2021
TYPE OF VISIT:	POC	UNANNOUNCED	TIME BEGAN:	01:05 PM
MET WITH:	Sheldon El		TIME COMPLETED:	03:45 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	Licensing Program Analyst (LPA) Amy Strother conducted an unannounced Plan of Correction (POC) visit regarding a Type A violation cited during a visit to the facility on 08/25/21. During the visit on 08/25/2021, Licensee, Sheldon El (L1) was cited for operating beyond the License capacity requirements. Specifically, L1 was cited for having 4 infants and 10 preschoolers in care with 2 assistants during the visit on 08/25/21. L1 stated that her plan of correction would include meeting with staff and coming up with a plan to schedule the children in a way that meets the ratio requirements of her FCCH and submit the plan to LPA Strother on 08/26/21 by 5pm. On 08/27/21 at 6:32am L1 emailed LPA Strother stating that L1 met with staff during a staff meeting on the evening of 08/26/21 and decided to terminate care for a couple of the families to bring the facility into compliance. On 08/27/21 LPA replied to L1’s email requesting additional information be submitted to LPA to clear the deficiency. LPA included an attachment in the email of an electronic copy of the facilities form LIC 9040 Child Care Facility Roster, submitted to the Department on 06/09/21. LPA requested that L1 add all additional children L1 has enrolled since 06/09/21, using additional pages as needed, and specifically instructed L1 to include the “date left” as documentation of the children L1 has terminated care for, demonstrating L1’s plan of correction. LPA requested that L1 submit the updated LIC9040 by 08/30/21. LPA Strother has not received an updated LIC9040 as of today’s date 09/07/21. During today’s visit, at LPA Strother’s request, L1 produced an updated copy of the Child Care Facility Roster, LIC9040. 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: 09/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2021

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: 09/07/2021

NARRATIVE

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The updated roster indicated that one child, Child 6 (C6) is no longer attending the facility as of 08/27/21, listed as the “date left” on form LIC9040. L1 also provided the facilities weekly schedule, demonstrating that no more than 3 infants are scheduled at any one time, along with 10 children that are preschool age.

LPA reviewed thirteen children's records at 1:50pm to ensure that children's records have a signed copy of the form LIC9224. Review of children's records for Child 1 – Child 13 (C1-C13) revealed that C1-C13’s file do not contain signed copies of form LIC9224. This report was reviewed and discussed with the Licensee. All licensing reports are public information and must be made available upon request for at least 3 years.

The following violation(s) of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Appeal Rights were provided.

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: Amy Strother	TELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2021

LIC809 (FAS) - (06/04)

Page: 3 of 3

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/07/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/21/2021 Section Cited	1 2 3 4 5 6 7	A licensed child care facility or home shall provide to the parents of each child receiving services in the facility copies of any licensing report that documents any Type A citation that represents an immediate risk to the health, safety, or personal rights of children in care as specified in paragraph
	8 9 10 11 12 13 14	(1) of subdivision (a) of Section 1596.893b. This requirement is not met as evidenced by: Review of children's records revealed that C1-C13 do not have signed copies of form LIC9224 in their files. This poses a potential health and safety risk to the children in care.	8 9 10 11 12 13 14	Licensee stated that she understands the signed copies of the LIC9224 go in each child's file to be kept for 3 years. amy.strother@dss.ca.gov
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy Strother	TELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2021

LIC809 (FAS) - (06/04)

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