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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483010297
Report Date: 01/16/2025
Date Signed: 01/16/2025 09:50:59 AM

Document Has Been Signed on 01/16/2025 09:50 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:SCRUGGS, NICOLE FCCHFACILITY NUMBER:
483010297
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
01/16/2025
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Nicole ScruggsTIME VISIT/
INSPECTION COMPLETED:
10:15 AM
NARRATIVE
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Licensing Program Analyst (LPA) Glenn Ouye arrived unannounced to conduct a capacity increase case management visit. LPA met with licensee Nicole Scruggs who owns the home.

The application for the capacity increase was received by the department on January 10, 2025. The approved fire clearance was received from the Vallejo Fire Department on January 14, 2025.

The fire alarm pull station is mounted on the wall just inside of the front door. There are functioning smoke and carbon monoxide detectors and a wall mounted fire extinguisher rated at 2A10BC.

The on-limits area for the children is the front den, the kitchen/dining area and the playroom behind the dining area.

The capacity increase to a large family child care home up to 14 children is approved effective January 16, 2025. The new license will be sent to the licensee

No deficiencies cited during the visit.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/16/2025
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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