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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 283010550
Report Date: 01/22/2025
Date Signed: 01/22/2025 03:16:52 PM

Document Has Been Signed on 01/22/2025 03:16 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:MORA ARENAS, EVELYN FCCHFACILITY NUMBER:
283010550
ADMINISTRATOR/
DIRECTOR:		MORA ARENAS, EVELYNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 260-4979
CITY:SAINT HELENASTATE: CAZIP CODE:
94574
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 15DATE:
01/22/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Evelyn Mora Arenas TIME VISIT/
INSPECTION COMPLETED:
03:25 PM
NARRATIVE
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On 01/22/25 unannounced case management deficiencies inspection was conducted. Licensing Program Analyst (LPA) Cindy Castro met with licensee, Evelyn Mora (L1). The facility’s operating hours are 7:00AM- 5:00PM, Monday – Friday. Today's census is 15 children.

At 10:35pm while touring the facility and conducting a headcount, LPA observed 15 children being cared and supervised by licensee and two staff. Five of those children being care for and supervised were infants between birth and 24 months. LPA informed licensee of Staffing and Ratio Capacity, Title 22 Regulations, for a large Family Child Care Home (FCCH) and printed capacity handout. Licensee stated that she is familiar with regulations regarding ratio and capacity.

Licensee further explained that she had 15 children because her son had a medical appointment today. LPA explained that due to capacity regulations licensee is only able to have 14 children max capacity and the max capacity for infants is four but that reduces the total capacity to 12 children maximum for a Large FCCH when those 4 infants are present. L1 contact the parent of Infant Child (C1) at 10:45am to be picked up and parent arrived at 11:05am. L1 added that she will cancel enrollment for two of the infants because she prefers to have the max capacity of 14 children.

LPA informed the licensee to provide a copy of this licensing report dated 01/22/25 that documents any Type. A citation 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: Erin Virrueta
LICENSING EVALUATOR NAME: Cindy Castro
LICENSING EVALUATOR SIGNATURE: DATE: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/22/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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 CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: MORA ARENAS, EVELYN FCCH
FACILITY NUMBER: 283010550
VISIT DATE: 01/22/2025
NARRATIVE
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Exit interview conducted and report was reviewed with Evelyn Mora. Appeal Rights were provided and discussed. A notice of site visit was given to licensee and must remain posted on, or immediately adjacent to, the interior.
side of the main door for 30 days.
SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Cindy Castro
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/22/2025 03:16 PM - It Cannot Be Edited


Created By: Cindy Castro On 01/22/2025 at 01:40 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: MORA ARENAS, EVELYN FCCH
FACILITY NUMBER: 283010550

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/22/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/23/2025
Section Cited
CCR
102416.5(d)(2)

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For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time ...shall be either: (2) More than twelve and up to fourteen children only if the criteria in Section 1597.465 of the Health and Safety Code are met.
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Licensee contacted parent of infant C1 to pick be picked up. C1 left facility at 11:05am. Licensee will submit a statement to the department by 01/23/25 that she undestands capacity and ratio requirements for a Large FCCH and that she will maintain ratios and capacity at all times of opearation.
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This requirement is not met as evidenced by:
Based on observation at 10:35am the licensee did not met the ratio requirements by caring for infant C1 which was a total headcount of 15 children, which poses and immediate Health, Safety and Personal Rights risk to
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Licensee will also submit an updated roster notating enrollement ending dates for the two children that she decided to end services with to maintain ratio and capcity requirements
Via mail, email, or fax: (707) 588-5099 Email:cindy.castro@dss.ca.gov

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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:Erin Virrueta
LICENSING EVALUATOR NAME:Cindy Castro
LICENSING EVALUATOR SIGNATURE:
DATE: 01/22/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/22/2025


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