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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 490170838
Report Date: 07/20/2021
Date Signed: 07/21/2021 02:46:21 PM

Document Has Been Signed on 07/21/2021 02:46 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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:ROSE, DIANE FAMILY CHILD CARE HOMEFACILITY NUMBER:
490170838
ADMINISTRATOR:ROSE, DIANEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 838-4632
CITY:WINDSORSTATE: CAZIP CODE:
95492
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
07/20/2021
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:11 PM
MET WITH:Diane RoseTIME COMPLETED:
03:52 PM
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An case management inspection was made to the facility by Licensing Program Analyst (LPA), Y. Yang. The licensee is requesting to return to active license status. A review of staff records on 07/20/2021 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. There is currently one adult living in the home.

During today’s inspection the home and grounds were toured. There were no children present at the facility. The facility’s operating hours are 08:30am to 02:30pm, Mon–Fri. The floor plan submitted by the licensee was reviewed and verified. The children have access to the home's childcare room and hall bathroom. The off-limits areas of the home are the home's bedrooms, living room, kitchen, and office, and were made inaccessible by door locks, door latches, and/or a child gate. The home was observed to be clean and orderly, and was at a comfortable indoor temperature. There were safe toys and equipment available for children. The licensee stated there is a working telephone in the home. The licensee’s pediatric CPR and First Aid certifications were reviewed and expire in January 2023. Items which could pose a danger to children (such as detergents, cleaning compounds, medications, etc.) were observed to be stored out of the reach of children. The licensee stated that she currently does not have any poisons stored at the facility. The LPA observed a working smoke detector, carbon monoxide detector and fire extinguisher, rated at least 2A10BC, in the home. The licensee stated that firearms and ammunition are not stored on the premises. The children use the home’s backyard as the outdoor play area; It is fully fenced. There is an above ground hot tub located in an off limits area of the licensee's backyard. The hot tub has a lockable hard cover and is fully fenced with a key locked gate. No children's files were reviewed today. The licensee currently does not have any children enrolled. Continued on LIC 809-C
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Yang Yang
LICENSING EVALUATOR SIGNATURE: DATE: 07/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/20/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME: ROSE, DIANE FAMILY CHILD CARE HOME
FACILITY NUMBER: 490170838
VISIT DATE: 07/20/2021
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The licensee currently does not have any children in care requiring Incidental Medical Services (IMS). The Incidental Medical Services (IMS) policy was discussed with the licensee. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department.

The following information regarding ADA was provided: US Department of Justice toll-free ADA Line at (800) 514-0301 (voice)/(800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, www.ada.gov/childqanda.htm. This report, as well as the AAP Guide to Safe Sleep Practices, The Effects of Lead Exposure brochure, and COVID guidelines and best practices were reviewed and discussed with the licensee. All licensing reports are public information and must be made available upon request for at least three years.

Notice of Site Visit shall be posted for 30 days from today's visit.

There were no Title 22 deficiencies cited during today's inspection.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Yang Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2021
LIC809 (FAS) - (06/04)
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