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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173009857
Report Date: 02/18/2022
Date Signed: 02/18/2022 11:38:17 AM

Document Has Been Signed on 02/18/2022 11:38 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:BROWN, CARRIE FCCHFACILITY NUMBER:
173009857
ADMINISTRATOR:BROWN, CARRIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 245-9154
CITY:CLEARLAKESTATE: CAZIP CODE:
95422
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
02/18/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Carrie BrownTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Glenn Ouye met with licensee Carrie Brown to change her inactive status to active status. LPA Ouye toured the home with licensee. The licensee submitted an updated sketch. She is making all of the bedrooms, the kitchen, dining room and living room are off limits. There two day care rooms and the children's bathroom in the hallway. The off limit areas are made inaccessible with child safety gates and door knob slip covers.

There is no fireplace and the home is a single story home. There are smoke detectors and a carbon monoxide detector which were tested and functional. The licensee has a posed emergency disaster drill log posted. All of there required posting are posted in the entry way and in the child care rooms.

LPA and the licensee discussed Covid-19 mitigation requirements such has daily wellness checks, masking requirements, hand washing and sanitation and reporting procedures.

The licensee and LPA also reviewed children's file set up and the facility file documents.

Based on the inspection and review of documents the facility license will be changed from inactive to active on February 18, 2022 (today).
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 02/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/18/2022
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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