<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483009411
Report Date: 11/12/2024
Date Signed: 11/12/2024 11:09:34 AM

Document Has Been Signed on 11/12/2024 11:09 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:MATHEWS, SAMANTHA FCCHFACILITY NUMBER:
483009411
ADMINISTRATOR/
DIRECTOR:		MATHEWS, SAMANTHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 486-6554
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 14TOTAL ENROLLED CHILDREN: 20CENSUS: 8DATE:
11/12/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Licensee Samantha MathewsTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst ( LPA) Elpidia Hernandez Torres arrived to the family child care home ( FCCH) on 11/12/24, to conduct a case management visit and provide any technical assistance that maybe needed. Upon LPAs arrival Licensee questioned the purpose of the visit and was not sure why LPA was present for an inspection if LPA was previously at the home a year ago. LPA went ahead and explained the purpose of the "required 3 year visit", and explained the various other reasons why a visit would be warranted.

While LPA was present, LPA reviewed certifications were up to date AB 1207 expires 11/2026, and pediatric CPR and first aid expires 11/2026. The last disaster drill conducted was on 11/01/24 it was a fire drill. Licensee and assistant were supervising 8 children, licensee was operating within ratio and capacity.

There were no deficiencies issued during todays visit. Notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE: DATE: 11/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/12/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1