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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 233010701
Report Date: 09/27/2024
Date Signed: 09/27/2024 02:05:22 PM

Document Has Been Signed on 09/27/2024 02:05 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:MACIAS BALLESTEROS, ERICKA FCCHFACILITY NUMBER:
233010701
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 6CENSUS: 6DATE:
09/27/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:24 PM
MET WITH:Ericka Macias BallesterosTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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A case management inspection was conducted to the facility by Licensing Program Anaylst (LPA) Robert Maciel in response to an increase capacity application received by the Department on 09/06/24 from Licensee, Ericka Macias Ballesteros (L1). The licensee is requesting a capacity of 14. Proof of control of property is on file. Because the applicant rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms it was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149). The Ukiah Valley Fire Authority inspected and granted a fire clearance on 09/24/2024. There is a functional smoke/carbon monoxide detector and a charged fire extinguisher in the facility. The fire pull station is located to the left of the inside of the front door and in the hallway. The licensee stated she clearly understand 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, and when an assistant provider must be present. The licensee understands if no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home. A review of staff records indicates that all current facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

Continue on LIC809-C

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Robert Maciel
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2024
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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: MACIAS BALLESTEROS, ERICKA FCCH
FACILITY NUMBER: 233010701
VISIT DATE: 09/27/2024
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The facility was toured inside and outside. The facility’s operating hours are 07:00am - 05:00pm, Monday - Friday. The floor and yard plans are verified. The children will have access to the living room, daycare room, downstairs bathroom and backyard. All other areas of the home are off-limits, made inaccessible by child safety gates and child proof latches. There is no spa, pool, pond, or fountain on the premises. None shall be added without prior approval of the Licensing agency. The licensee has current pediatric CPR and First Aid certification, which expires 07/2026 and current mandated reporter training, which expires 7/2026. Licensee understands that any assistant must stay current on their mandated reporter training, immunizations, and if left alone with children in care, must maintain a current Pediatric First Aid/CPR certification.

The increase capacity to 14, as a Large Family Child Care Home is granted as of today, 09/27/24.

An exit interview has been conducted and this report has been reviewed with the licensee, Ericka Macias Ballesteros.

Notice of Site Visit shall be posted for 30 days.

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Robert Maciel
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2024
LIC809 (FAS) - (06/04)
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