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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493002572
Report Date: 08/26/2020
Date Signed: 08/27/2020 10:01:11 AM

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:BOUDREAU, YVONNE FAMILY CHILD CARE HOMEFACILITY NUMBER:
493002572
ADMINISTRATOR:BOUDREAU, YVONNEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 578-0967
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY:14CENSUS: 0DATE:
08/26/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Yvonne BoudreauTIME COMPLETED:
03:30 PM
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The facility inspection was conducted via tele-inspection due to the Covid-19 state of emergency pandemic. The department has suspended all field operations and the applicant has agreed to conduct the video conference with LPA, (Licensing Program Analyst) Glenn Ouye.

LPA Ouye conducted the video conference with licensee Yvonne Boudreau for the purpose of a capacity increase as she is changing from a small to a large Family Child Care Home. The application for the capacity change was received on July 20, 2020. The Santa Rosa Fire Inspector conducted the conducted the fire safety inspection on August 5, 2020. A copy of the approved fire safety inspection was received on August 27, 2020.

The licensee toured the LPA through the home using her cell phone video capability. The licensee showed LPA the installed fire pull station and the wall mounted fire extinguisher. The licensee also showed and tested a functioning carbon monoxide and smoke detectors in her home. The licensee also showed LPA her current and posted fire drill evacuation log.

The licensee has met the requirements to operate as a large family child care home and is approved to operate as such effective August 27, 2020.

A new license showing a capacity of 14 children will be issued to the licensee.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Glenn OuyeTELEPHONE: (707) 588-5042
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2020
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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