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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 283010097
Report Date: 04/24/2024
Date Signed: 04/24/2024 12:48:17 PM

Document Has Been Signed on 04/24/2024 12:48 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 CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:MARIN, ARACELI FCCHFACILITY NUMBER:
283010097
ADMINISTRATOR/
DIRECTOR:		MARIN, ARACELIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 304-3422
CITY:NAPASTATE: CAZIP CODE:
94558
CAPACITY: 14TOTAL ENROLLED CHILDREN: 13CENSUS: 6DATE:
04/24/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Araceli MarinTIME VISIT/
INSPECTION COMPLETED:
12:50 PM
NARRATIVE
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On 04/24/24 Licensing Program Analyst (LPA), Cindy Castro arrived to conduct an unannounced case management deficiency visit. Upon arrival LPA was greeted by Adult (A1), who was caring and supervising 6 children. Licensee was called by A1 and arrived 10 minutes later to Family Child Care Home (FCCH).

At 9:30 AM, LPA Cindy Castro observed uncleared adult (A1) present in the facility providing care and supervision to six children. Interviews with Licensee and A2 revealed A1 had been an employee at the daycare since January 2024. Interviews with children also corroborated that A1 was a staff member at the daycare. The following deficiency 102370(d)(1) is cited on LIC 809-D and $500 civil penalty is being assessed because the Licensee did not comply with requirements of criminal record clearance.

This report was reviewed with licensee and was provided with a copy and appeal rights.

This report dated 04/24/24 document(s) one Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care. Also, LPA informed the licensee to provide a copy of this licensing report and Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/ guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Cindy Castro
LICENSING EVALUATOR SIGNATURE: DATE: 04/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/24/2024
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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Document Has Been Signed on 04/24/2024 12:48 PM - It Cannot Be Edited


Created By: Cindy Castro On 04/24/2024 at 12:04 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: MARIN, ARACELI FCCH
FACILITY NUMBER: 283010097

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/25/2024
Section Cited
CCR
102370(d)(1)

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102370(d)(1) Criminal Record Clearance
All individuals subject to a criminal record review... shall prior to working...in a licensed facility:
(1) Obtain a California clearance
This requirement is not as evidenced by:
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Adult #1 left the facility premises on 04/24/24. Licensee stated that she will have A1 complete a live scan or not return to facility. Licensee will submit proof to the department if A1 completes live scan. Additionally Adult#1 will not return to facility until fully cleared.
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Based on interview, observation and record review, Licensee did not ensure Adult #1 had a Criminal Record Clearance, which poses an immediate risk to the Health, Safety and Personal rights of the children in care.

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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
LICENSING EVALUATOR NAME:Cindy Castro
LICENSING EVALUATOR SIGNATURE:
DATE: 04/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/24/2024


LIC809 (FAS) - (06/04)
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