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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483010227
Report Date: 07/02/2024
Date Signed: 07/02/2024 12:07:56 PM

Document Has Been Signed on 07/02/2024 12:07 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:PEARSALL, ANTOINETTE FCCHFACILITY NUMBER:
483010227
ADMINISTRATOR/
DIRECTOR:
FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 7CENSUS: 5DATE:
07/02/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:10 AM
MET WITH:Antoinette PearsellTIME VISIT/
INSPECTION COMPLETED:
12:23 PM
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A case management inspection was conducted to the facility by Licensing Program Analyst (LPA), Robert Maciel in response to an increase capacity application received by the Department on 03/27/24. The licensee is requesting a capacity of 14. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. The facility was toured inside and outside. The facility’s operating hours are 8:30 AM to 04:30 PM, Monday - Friday. The floor plan submitted by the licensee was reviewed and verified. The children will have access to the daycare room, dinning room, down stairs half bathroom and the backyard. The backyard is completely fenced. The "off limits" areas include the home's entire second floor and all its bedrooms, the living room, laundry room, garage and kitchen. These areas have been made inaccessible by doorknob slipcovers and child safety gates. There were no pools or other bodies of water observed on premises. The home was observed to be clean and orderly and was at a comfortable indoor temperature. There is a working telephone in the home. Items which could pose a danger to children (detergents, cleaning compounds, and medications) were stored out of the reach of children. There is a working smoke detector, carbon monoxide detector and fire extinguisher in the home. The licensee has a current roster of children in care and has conducted an emergency drill within the past six months, on 05/17/24. There are no firearms in the home, and none were observed during the inspection. Pediatric CPR and Pediatric First Aid cards expire 08/13/24. The Suisun Fire Marshall inspected and granted the fire clearance on 06/27/24. All licensing reports are public information and must be made available upon request for at least three years.

The increase capacity to 14, as a Large Family Child Care Home is granted as of today, 07/02/24.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Robert Maciel
LICENSING EVALUATOR SIGNATURE: DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/02/2024
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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