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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173010323
Report Date: 03/21/2023
Date Signed: 03/21/2023 03:02:49 PM

Document Has Been Signed on 03/21/2023 03:02 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:ZIMMERMAN, CLAIRE FCCHFACILITY NUMBER:
173010323
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
03/21/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Claire ZimmermanTIME COMPLETED:
03:10 PM
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On 03/21/2023 at 01:30PM, Licensing Program Analyst (LPA), Sebastian Phouthavong made an announced Case Management visit to the facility met with Licensee, Claire Zimmerman; regarding remodeling done to the home.

During the visit, LPA toured the facility inside and out and observed no children in care. LPA observed parts of the downstairs garage remodeled into the childcare room. The children will have access to areas of the home including the living room, dining room, kitchen, downstairs childcare room, and upstairs/downstairs bathrooms. The “off-limits" areas include all the bedrooms, the downstairs bedroom, and garage. These areas will be made inaccessible by door locks, latches, doorknob covers, and/or child gates. There were safe toys and equipment available for children. LPA observed a working smoke detector, carbon monoxide detector and fire extinguisher, rated at least 2A10BC, in the home. Licensee stated she plans to mainly use the childcare room during operating hours. Licensee has submitted an updated Facility Sketch to CCL.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee, Claire Zimmerman.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE: DATE: 03/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2023
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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