<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173010706
Report Date: 07/08/2024
Date Signed: 07/08/2024 10:17:48 AM

Document Has Been Signed on 07/08/2024 10:17 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:ROLDAN ARREOLA, LAURA FCCHFACILITY NUMBER:
173010706
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 10CENSUS: 0DATE:
07/08/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Laura Roldan ArrolaTIME VISIT/
INSPECTION COMPLETED:
10:25 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
Licensing Program Analyst (LPA) Sebastian Phouthavong arrived to conduct a change of location prelicensing inspection. An application was received to the department on 07/02/2024 for the change of location. Services will be available Monday - Saturday, 6:00 AM - 6:00 PM. The licensee understands that 24hr consecutive care is prohibited. There are currently one adult living in the home.

During the inspection the home was toured inside and outside. The floor plan submitted by the licensee was reviewed and verified. The children will have access to the living room, kitchen, Child care room, hallway bathroom and backyard porch. The off-limits areas include two bedrooms, one bathroom, garage and main section of the backyard. The off-limits areas of the home were made inaccessible by door locks, plastic doorknob covers and/or child gates.

There are no poisons in the home and the regulation that poisons are to be locked using a key or combination lock was reviewed. Licensee stated there are no firearms and any other dangerous weapons in the home and none were observed during today's inspection. There is a functioning smoke detector and carbon monoxide detector. The fire extinguisher is rated at 2A10BC. First aid supplies will maintained at the facility at all times. The home's yard is fully fenced. There were no pools or other bodies of water observed.

The facility is approved for licensure effective today, July 08, 2024

Exit interview conducted and report was reviewed with the Licensee, Laura Roldan Arrola.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE: DATE: 07/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/08/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1