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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493008329
Report Date: 08/07/2024
Date Signed: 08/07/2024 01:48:05 PM

Document Has Been Signed on 08/07/2024 01:48 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:HARTLEY, LISA FCCHFACILITY NUMBER:
493008329
ADMINISTRATOR/
DIRECTOR:		HARTLEY, LISAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 539-5028
CITY:SANTA ROSASTATE: CAZIP CODE:
95409
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 6DATE:
08/07/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:37 AM
MET WITH:Lisa HartleyTIME VISIT/
INSPECTION COMPLETED:
01:02 PM
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A Required Annual inspection was made to the facility by Licensing Program Analyst (LPA), Robert Maciel who met with Licensee Lisa Hartley to continue an inspection that began on 08/02/2024 and to follow up on deficiencies that were issued on 08/02/2024.

During the annual inspection and complaint investigation visit on 08/02/2024, the facility was cited 6 violations which include the Licensee not being present in the home for at least 80% of the facility's hours of operation, cleaning chemicals in the laundry room being accessible to children, the facility not possessing record of disaster drills performed within the last 6 months, infant bedding being used for more than 1 infant, staff 1 (S1) and staff 2 (S2) not possessing current mandated reporter training certificates, and child 1 (C1) and child 2 (C2) not possessing LIC9227 Individual Infant Sleeping Plans.



During today’s inspection the home and grounds were toured and files were reviewed. The Licensee was supervising 6 children and was operating within the licensed capacity and ratio requirements. LPA observed that the laundry room door was locked with a child lock, the hallway baby gate was closed. LPA observed C1 and C2 sleeping in separate play pens in the play room. Licensee showed LPA a calendar where the facility disaster drills are recorded onto. The most recent drill was recorded on 7/1/24. LPA gave licensee a form to more easily record disaster drills which she stated she would use henceforth to record disaster drills. Licensee showed LPA a record of sleep logs performed for C1, C2, and child 3 (C3) for the month of July 2024. LPA did not observe the Notice of Site Visit dated 8/2/24. Licensee stated that she did not receive the notice from S2 and could not find it in the home.

Licensee stated that she would ensure S1 obtains a current mandated reporter training certificate but that S2 was no longer working at the facility. Licensee stated that she would obtain completed LIC9227 Individual Infant Sleeping Plans for C1 and C2.

Continued on LIC809-C
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Robert Maciel
LICENSING EVALUATOR SIGNATURE: DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/07/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: HARTLEY, LISA FCCH
FACILITY NUMBER: 493008329
VISIT DATE: 08/07/2024
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No children were observed left in any parked vehicles. The floor plan submitted by the licensee was reviewed. The children will have access to the backyard, the playroom shed in the backyard, the playroom, bedroom 3, and the bathroom in the playroom. The off-limits areas of the home are the backyard shed, the master bedroom, bedroom 2, the living room, the kitchen, bedroom 4, the garage, and the front yard. The off-limits areas of the home were made inaccessible by door locks, door latches and child gates. Licensee stated that she plans on making the master bedroom on limits and would submit an updated LIC999 Facility Sketch reflecting the change. Licensee’s pediatric CPR/First Aid certification was current and expires in January 2025. The licensee stated that poisons are stored in the garage. LPA observed that while inaccessible to children in care, the poisons were not locked. The regulation that poisons are to be locked using a key or combination lock was reviewed. Licensee moved the poisons to the backyard shed, which was locked with a padlock.

The Licensee stated that there are no firearms in the home and none were observed. LPA observed no bodies of water in the facility.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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 (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Continued on LIC809-C
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Robert Maciel
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024
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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: HARTLEY, LISA FCCH
FACILITY NUMBER: 493008329
VISIT DATE: 08/07/2024
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On this date, 08/02/2024, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility address. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ. During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.


The following violation(s) of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Appeal Rights were provided. Exit interview conducted and report was reviewed with Licensee Lisa Hartley. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Robert Maciel
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/07/2024 01:48 PM - It Cannot Be Edited


Created By: Robert Maciel On 08/07/2024 at 12:13 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: HARTLEY, LISA FCCH
FACILITY NUMBER: 493008329

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/07/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8565(a)(1)
Each licensed child day care facility shall post a copy of any licensing report pertaining to the facility that documents either a facility visit or a complaint investigation that results in a citation for a violation that, if not corrected, will create a direct and immediate risk to the health, safety, or personal rights of children in care. The licensing report provided by the department shall be posted immediately upon receipt, adjacent to the postings required pursuant to Section 1596.817 and on, or immediately adjacent to, the interior side of the main door to the facility and shall remain posted for 30 consecutive days.
This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not post the notice of site visit to the entrance of the facility which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/14/2024
Plan of Correction
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LPA gave the Licensee a copy of the notice of site visit to repost to the entrance of the facility and Licensee stated she would write a statement attesting to her understanding of the regulation and submit it to LPA by email at robert.maciel@dss.ca.gov.
Type B
Section Cited
HSC
1596.8565(c)(3)
The licensee shall require each recipient of the licensing report described in paragraph (1) pertaining to a complaint investigation to sign a statement indicating that he or she has received the document and the date it was received.
This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not obtain signed statements from parents of enrolled children indicating receipt of the licensing report dated 08/02/2024 documenting a type A citation which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/14/2024
Plan of Correction
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Licensee stated she would write a statement attesting to her understanding of the regulation and would obtain all signed statements required from parents of currently enrolled children and send copies to LPA by email at robert.maciel@dss.ca.gov.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Alexis Hollon
LICENSING EVALUATOR NAME:Robert Maciel
LICENSING EVALUATOR SIGNATURE:
DATE: 08/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/07/2024


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