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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493009764
Report Date: 08/26/2021
Date Signed: 08/26/2021 11:30:11 AM

Document Has Been Signed on 08/26/2021 11:30 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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:MEYER, SABRINA FCCHFACILITY NUMBER:
493009764
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
08/26/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Sabrina MeyerTIME COMPLETED:
11:45 AM
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A required-1 year inspection was made to the facility by Licensing Program Analyst (LPA) Amy Strother. A review of records on 08/26/21 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 are currently 3 adults living in the home.
During today’s inspection the home and grounds were toured. The licensee was supervising 2 preschool children and 3 infants, and operating within the licensed capacity and ratio requirements. No children were observed left in any parked vehicle. The facility’s operating hours are 7:30am-6:30pm, M-F. The floor plan submitted by the licensee was reviewed with the Licensee who stated that she wants to make some changes to the on-limits and off-limits areas. Licensee stated that all of the bedrooms are now off-limits and the detached room in the backyard is now on limits. Licensee will submit an updated LIC999A to LPA by 08/30/21. The off-limits areas of the home are the three bedrooms, and the basement. These areas have been made inaccessible by means of locking latches and/or locked door knobs. The home was clean and orderly, and was at a comfortable indoor temperature. There were safe toys and equipment available for children. There is a working telephone in the home. The licensee has current pediatric CPR and First Aid certification online and is enrolled to attend the in person course on 10/23/21. LPA verified a current mandated reporter training certificate, which expires 06/22/2023. Items which could pose a danger to children (detergents, cleaning compounds, medications, etc.) were stored out of the reach of children. The licensee stated no poisons are located on the property, and none were observed during today's inspection. The fireplace in the living room has been made inaccessible with a wooden cabinet. There is a working combination smoke detector/carbon monoxide detector in the hallway, and a 2A10BC fire extinguisher in the kitchen. Licensee stated that no firearms or ammunition are in the home and none were observed during today's inspection. The Licensee has cots available for nap time and a crib was available for the infant in care. LPA reviewed the safe sleep log used for children under age two and form LIC9227 for each infant under 12 months of age.

Continue on LIC809-C
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE: DATE: 08/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2021
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: MEYER, SABRINA FCCH
FACILITY NUMBER: 493009764
VISIT DATE: 08/26/2021
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The children use the back yard as the outdoor play area and it is fully fenced. Three children's records were reviewed at 10:30AM; required emergency information was observed to be on file. The licensee does not currently have children enrolled that require 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.
(Continue to LIC 809-C)

The following information regarding ADA was provided: US Department of Justice 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, www.ada.gov/childqanda.htm. This report, as well as the AAP Guide to Safe Sleep Practices and The Effects of Lead Exposure brochures, 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.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021
LIC809 (FAS) - (06/04)
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