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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483010013
Report Date: 07/26/2022
Date Signed: 07/26/2022 02:31:32 PM

Document Has Been Signed on 07/26/2022 02:31 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:LITTLE BLESSINGS DAYCARE-INFANTFACILITY NUMBER:
483010013
ADMINISTRATOR:BARRON BOTELLO, MARTHAFACILITY TYPE:
830
ADDRESS:717 KENTUCKY STREETTELEPHONE:
(707) 720-9706
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 7TOTAL ENROLLED CHILDREN: 7CENSUS: 6DATE:
07/26/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Licensee Martha Barron BotelloTIME COMPLETED:
02:35 PM
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Licensing Program Analyst ( LPA) Elpidia Hernandez Torres arrived to facility to verify plan of corrections (POC) had been completed from a deficiency issued during an annual inspection on 07/19/2022. From the annual inspection, there were seven infants missing the infant services and needs plan. Licensee agreed to create a template for an infants services and need plan and work with guardians to complete the document. LPA reviewed the seven infants files and found three infants had the infants needs and services plan. Licensee stated four infants were missing the document as guardians were revising the plan and needed to sign and submit the form. A technical Advisory was given on 07/19/2022 for infants missing admissions agreement. All seven infants had the admissions agreement in their file. The deficiency has been corrected and a POC Letter was printed and given to Licensee. No deficiencies were observed during todays visit.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE: DATE: 07/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/26/2022
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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