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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493008417
Report Date: 05/02/2022
Date Signed: 05/02/2022 03:04:02 PM

Document Has Been Signed on 05/02/2022 03:04 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:ROSS, SHAELA FCCHFACILITY NUMBER:
493008417
ADMINISTRATOR:ROSS, SHAELA & ROBYNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 483-9741
CITY:SANTA ROSASTATE: CAZIP CODE:
95405
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
05/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Shaela RossTIME COMPLETED:
02:30 PM
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An annual required inspection of the facility was conducted by Licensing Program Analyst, Jennifer Velasco (LPA), who met with Licensee Shaela Ross (L1). 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. L1 was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated. The facility’s operating hours are 7:30 a.m. - 6:30 p.m., Monday-Friday, year-round. During today’s inspection, the facility was toured inside and outside, and the floor and yard plan submitted by L1 were verified. The on limits areas are the classroom, playroom, bathroom, one side yard, and fully fenced playground part of the backyard. The off-limits areas are the other, also fenced part of the backyard, three bedrooms, two bathrooms, kitchen, formal living room, closets, one side yard, and the backyard shed. These are rendered inaccessible by way of key locks, doorknob covers, gates, and slide locked doors. The items which could pose a danger to children (such as detergents, cleaning compounds, and medications) were observed to be stored in a locked cabinet in the preschool classroom and above the refrigerator in the kitchen and inaccessible to children. L1 stated there are no poisons in the facility, and none were observed. The toys, floors, desks, and other equipment and surfaces were clean, toxic free, safe, and in good condition. The children's bathroom was in safe, sanitary, and operable condition. Food prep areas were clean. Food was properly stored and refrigerated as needed. The fully fenced playground was free of hazards. The playground equipment and surface areas were in safe condition. There was pea gravel to provide cushioning underneath climbing structures to absorb falls. There were no swimming pools or other bodies of water observed on the property. Licensee stated no weapons are stored on site and none were observed.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Jennifer Velasco
LICENSING EVALUATOR SIGNATURE: DATE: 05/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/02/2022
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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: ROSS, SHAELA FCCH
FACILITY NUMBER: 493008417
VISIT DATE: 05/02/2022
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During today's inspection, staffing ratios were being met. Three staff were supervising 14 children. The facility was operating within the licensed capacity. At least one staff member present during the inspection possessed current pediatric CPR and First Aid certifications, which expire in 12/2023. Three children’s records were reviewed at 11:35 a.m. and contained signed Admission Agreements and Parents' Rights forms. Three staff records were reviewed at 11:55 a.m. and contained documentation of education and training as required. LPA and L1 discussed the safe sleep regulations and the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed L1 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 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 (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: http://www.ada.gov/childqanda.htm 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. Exit interview conducted and report was reviewed with L1. There were no Title 22 deficiencies cited during today's inspection. To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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-process
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Jennifer Velasco
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2022
LIC809 (FAS) - (06/04)
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