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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483001109
Report Date: 04/22/2024
Date Signed: 04/22/2024 03:09:25 PM

Document Has Been Signed on 04/22/2024 03:09 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:SMITH, JEANETTE FAMILY CHILD CARE HOMEFACILITY NUMBER:
483001109
ADMINISTRATOR/
DIRECTOR:		SMITH, JEANETTEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 422-3182
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 1DATE:
04/22/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:35 PM
MET WITH:Licensee Jeanette SmithTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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Licensing Program Analyst ( LPA) Elpidia Hernandez Torres arrived to family child care home to conduct a plan of correction visit. LPA was previously at the home on 04/04/2024 to conduct an inspection. On 04/04/2024 licensee was issued two type b deficiencies; one for having incomplete children's records, and the other deficiency was for missing sleep logs for infant in care.

LPA received email from licensee on 04/11/2024- with the completed files for two children enrolled. LPA reviewed the items and verified they were completed.

LPA asked for the sleep log for the infant enrolled, licensee reported the infant has not been to the day care since 04/05/2024, so there are no sleep logs. Licensee reported when the infant returns back to the day care she will begin to document the sleep logs again.

The deficiencies issued on 04/04/2024 have been cleared as of 04/22/2024.
There were no deficiencies issued during todays visit.

Notice of site visit was given and must remain posted for 30 days. Exit interview was conduct and report was reviewed with licensee Jeanette Smith.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE: DATE: 04/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/22/2024
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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