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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483005568
Report Date: 05/26/2023
Date Signed: 06/13/2023 11:47:37 AM

Document Has Been Signed on 06/13/2023 11:47 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:RICHARDSON, PHANDRA FAMILY CHILD CARE HOMEFACILITY NUMBER:
483005568
ADMINISTRATOR:RICHARDSON, PHANDRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 557-5487
CITY:VALLEJOSTATE: CAZIP CODE:
94589
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
05/26/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Phandra RichardsonTIME COMPLETED:
09:45 AM
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**Document is an amendment**

Licensing Program Analysts (LPAs), Robert Maciel and M. Augustin, conducted a Plan of Correction (POC) visit and met with Licensee, Phandra Richardson (LS) to address overdue POC's. On 05/13/2023, the facility was cited several deficiencies for not furnishing required immunization record and a record for S1. Furthermore, LS was cited for not transferring a napping infant to a play yard and not notifying the Department and/or furnishing permits related to a room addition construction project in the backyard.

During today’s visit, LS stated she had not obtained required immunization record for S1, and LS did not furnish a complete record for S1. LS submitted a written statement detailing she would transfer napping infants to a play yard to sleep and stated she did not have any additional permits to provide. The Department granted LS an extension on her POC from 05/14/23 through 05/22/23. A civil penalty of $400 was assessed because LS did not submit or clear her POC's by the POC due date. Today, LS requested an extension on her POC due date to obtain required immunization record for S1. The Department is granting LS an extension of 14 days to obtain S1’s required immunization, and the POC will be due by 06/09/23.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with the Licensee. Appeal rights were provided.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE: DATE: 05/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/26/2023
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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