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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483007744
Report Date: 08/31/2021
Date Signed: 08/31/2021 12:13:29 PM

Document Has Been Signed on 08/31/2021 12:13 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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:LINNEAR, GLORIA FCCHFACILITY NUMBER:
483007744
ADMINISTRATOR:LINNEAR, GLORIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 422-2075
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/31/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Donald Richardson Licensee's sonTIME COMPLETED:
12:30 PM
NARRATIVE
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An annual required inspection was made to the facility by Licensing Program Analysts (LPAs), Glenn Ouye and Elpidia Hernandez Torres. A review of staff records on 08/31/21 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. There are currently 2 adults living in the home.

During today’s inspection the home and grounds were toured. There were no children in care. The day care is closed, the department has no notice on file stating as such. Licensee is on vacation, Licensee's son has agreed to continue with inspection. No children were observed left in any parked vehicle. The facility’s operating hours are 06:30AM to 07:30PM, Monday–Friday. The floor plan submitted by the licensee was reviewed and updated by licensee's son. The off-limits areas of the home are the three bedrooms, two hall closets, garage, side patio and back yard. They were made inaccessible by Door knob slip covers. The home was clean and orderly, and was at a comfortable indoor temperature. There were safe toys and equipment available for children. There is a working telephone in the home. The licensee has current pediatric CPR and First Aid certification, which expire on 06/2023, and 07/2023. Items which could pose a danger to children (detergents, cleaning compounds, medications, etc.) were stored out of the reach of children. There is a working smoke detector, carbon monoxide detector and fire extinguisher, rated at least 2A10BC, in the home.

Continued on 809-C
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE: DATE: 08/31/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2021
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 08/31/2021 12:13 PM - It Cannot Be Edited


Created By: Elpidia Hernandez Torres On 08/31/2021 at 10:40 AM
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
, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: LINNEAR, GLORIA FCCH
FACILITY NUMBER: 483007744

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/31/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/10/2021
Section Cited
CCR
102417(g)(8)

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Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.
This requirement has not been met as evidence by. . . .
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Licensee's son stated the form will be reviewed and completed by 09/10/2021. Moving forward when enrolling a child daycare will ensure all boxes are completed on LIC 9040.
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LPAs asked for copy of roster LIC 9040, licensee's son provided the document with the following boxes missing data on all three pages: Facility name, Facility number, date/update, and phyiscian name and phone. This poses a potential health and saftey risk to children in care.
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LPA will receive proof form has been filled out by form of email, mail or fax:

elpidia.hernandez-torres@dss.ca.gov
Fax 707-588-5099
mail: 101 Golf course Drive Ste. A230
Rohnert Park, CA 94928
Type B
09/10/2021
Section Cited
CCR102417(g)(7)

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An emergency information card shall be maintained for each child and shall include. . . , . . .the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.
This requirement has not been met as evidence by. . .
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Licensee's son stated the form will be reviewed and completed by 09/10/2021. Moving forward all files will be reviewed and parents contacted to update LIC 700.
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During children's records review, LPAs noticed child 02, didn't have LIC 700 completly filled out missing physicians information and guardian's signiture. This poses a potential health and saftey risk to children in care.
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LPA will receive proof form has been filled out by form of email, mail or fax:

elpidia.hernandez-torres@dss.ca.gov
Fax 707-588-5099
mail: 101 Golf course Drive Ste. A230
Rohnert Park, CA 94928
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:Leslie Lepori
LICENSING EVALUATOR NAME:Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE:
DATE: 08/31/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/31/2021


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/31/2021 12:13 PM - It Cannot Be Edited


Created By: Elpidia Hernandez Torres On 08/31/2021 at 10:55 AM
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
, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: LINNEAR, GLORIA FCCH
FACILITY NUMBER: 483007744

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/31/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/10/2021
Section Cited
CCR
102417(g)(9)

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Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. . . .
This requirement was not met as evidence by. . .
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Licensee's son printed and filled out 610A, and posted it before LPAs left the facility. LPA was able ot take a picture of the form.
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During the tour LPAs did not observe the LIC 610A posted. During record review LPAs asked for the document, and LIcensee's son was unable to produce it. This poses a potential health and saftey risk to children in care.
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Type B
09/10/2021
Section Cited
CCR102417(g)(9)(a)

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Each family child care home shall conduct fire drills and disaster drills at least once every six months.
This requirement was not met as evidence by. . .
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Licensee's son stated either a fire drill or disaster drill will be completed and logged by 09/10/2021. And proof of the drill will be emailed to LPA Hernandez Torres
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During record review LPAs asked for a copy of the fire/ disaster drill log. Licensee's son was unable to produce the document. This poses a potential health and saftey risk to children in care.
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LPA will receive proof form has been filled out by form of email, mail or fax:

elpidia.hernandez-torres@dss.ca.gov
Fax 707-588-5099
mail: 101 Golf course Drive Ste. A230
Rohnert Park, CA 94928
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:Leslie Lepori
LICENSING EVALUATOR NAME:Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE:
DATE: 08/31/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/31/2021


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Document Has Been Signed on 08/31/2021 12:13 PM - It Cannot Be Edited


Created By: Elpidia Hernandez Torres On 08/31/2021 at 11:05 AM
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
, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: LINNEAR, GLORIA FCCH
FACILITY NUMBER: 483007744

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/31/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/10/2021
Section Cited
HSC
1596.8662(b)(1)

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. . . a person who,. . . is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training. . . and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
This requirement has not been met as evidence by. . .
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Licensee's son staed the traning will be complete by 09/10/2021, and certificate will be emailed to LPA Hernandez Torres.
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During record review, Licensee's son was not able to produce a copy of mandated reporter certificate for either Licensee or himself. This poses a potential risk to chidlren in care.
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LPA will receive certificate by form of email, mail or fax:

elpidia.hernandez-torres@dss.ca.gov
Fax 707-588-5099
mail: 101 Golf course Drive Ste. A230
Rohnert Park, CA 94928

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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:Leslie Lepori
LICENSING EVALUATOR NAME:Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE:
DATE: 08/31/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/31/2021


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
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME: LINNEAR, GLORIA FCCH
FACILITY NUMBER: 483007744
VISIT DATE: 08/31/2021
NARRATIVE
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 The licensee's son stated there are no firearms and/or other dangerous weapons in the home, and none were observed during today's inspection. The back yard, and both side patios is now off limits as the outdoor play area. There were no pools or other bodies of water observed in the yard. Three children's records were reviewed at 10:07AM; at 10:11AM Child 02's required emergency information form was observed to be not completed. At 10:30AM LPAs attempted to conduct a record review, and found the following items missing and/or incomplete; LIC 9040, missing Mandated reporter training certificate for both Licensee and Son, missing Fire drill/disaster log, and missing LIC 610A Emergency disaster plan. The licensee's son stated the family child care home is not providing Incidental Medical Services (IMS) to children in care. The Incidental Medical Services (IMS) policy was discussed with the licensee. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department.

The following information regarding ADA was provided: US Department of Justice toll-free ADA Information Line at (800) 514-0301 (voice)/(800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, www.ada.gov/childqanda.htm. This report, as well as the AAP Guide to Safe Sleep Practices and The Effects of Lead Exposure brochures, were reviewed and discussed with the licensee. All licensing reports are public information and must be made available upon request for at least three years.

Notice of Site Visit shall be posted for 30 days from today's visit.
The following violation(s) of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Appeal Rights were provided.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2021
LIC809 (FAS) - (06/04)
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