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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483010136
Report Date: 03/22/2022
Date Signed: 03/22/2022 11:12:07 AM


Document Has Been Signed on 03/22/2022 11:12 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:MELGAR IVANIA & CECILIA FCCHFACILITY NUMBER:
483010136
ADMINISTRATOR:IVANIA & CECILIA MELGARFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 386-3076
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY:14CENSUS: 1DATE:
03/22/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Licensee Ivania MelgarTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Elpidia Hernandez Torres conducted a record review, reviewed Safe Sleep Regulations, and Staffing Ratio and Capacity regulation. Licensee emailed LPA on Friday 03/18/2022 asking about safe sleep regulations and Ratio requirements, LPA was in the area and decided to stop by to print out the regulations review them and provide technical assistance with Licensee. Licensee was not using Sleep Log for infants over 12 months, LPA advised Licensee to begin using the sleep log moving forward for infants 24 months and younger and the infant sleep plan ( LIC 9227) for infants 12 months and younger. When reviewing the ratio and capacity guide, LPA explained to Licensee as a Large Family Child Care Home when Assistant is present she is allowed to care for; four infants with 8 children over the age of 2 given one of them is 6 years old and the other is enrolled and attending kindergarten, or Licensee may have Three infants in addition to 11 children over the age of 2 given one of them is 6 years old and the other is enrolled and attending kindergarten. LPA reminded Licensee when no assistant is present her Staffing ratio and Capacity revert back to a Small Family Child Care Home.

Notice of Site Visit must be posted for 30 days. No Deficiencies Sited today.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Elpidia Hernandez TorresTELEPHONE: (707) 771-5568
LICENSING EVALUATOR SIGNATURE:
DATE: 03/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2022
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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