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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010194
Report Date: 06/23/2022
Date Signed: 06/23/2022 11:13:29 AM

Document Has Been Signed on 06/23/2022 11:13 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:YWCA STARS INFANT-GUERNEWOODFACILITY NUMBER:
493010194
ADMINISTRATOR:MICHELLE SWEENWYFACILITY TYPE:
830
ADDRESS:17120 HWY. 116TELEPHONE:
(707) 604-7652
CITY:GUERNEVILLESTATE: CAZIP CODE:
95446
CAPACITY: 10TOTAL ENROLLED CHILDREN: 10CENSUS: 0DATE:
06/23/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Jynx LopezTIME COMPLETED:
09:30 AM
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Licensing Program Analyst (LPA) Glenn Ouye conducted a prelicensing visit to complete the licensing process for the YWCA Stars Infant Guernewood site. The application was received by the department on April 25, 2022. The approved fire clearance has been received from Sonoma County Fire Dept. The application is for a change of entity. There is no change of operations and staff at the site. All staff criminal record clearances have been transferred from the old license to this license. The hours of operation are Monday through Friday 7:30am to 5:30pm.

The facility was inspected and the a capacity determination of the indoor and outdoor activity space has been completed. Both the interior and exterior square footage supports the application capacity of ten infants. There is a sink within arms reach of the changing tables. There are sufficient cribs and mats/cots for the infants.

There are age appropriate toys, furniture and equipment in the facility. The outdoor activity area also has age appropriate equipment.

The applicant was reminded that all adults 18 years and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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 Child Care Center. 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.

LPA reviewed with applicant, the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted. Due to the change of entity the facility will be obtaining new admission packets for the attending children.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/23/2022
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: YWCA STARS INFANT-GUERNEWOOD
FACILITY NUMBER: 493010194
VISIT DATE: 06/23/2022
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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.
To receive important licensed - related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

LPA discussed the safe sleep regulations with applicant 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 [applicant, licensee, or facility representative] 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.

The applicant has 180 days after licensure to complete the required water lead testing if required per Health & Safety Code 1597.16.

The change of entity application has been approved and the license is approved effective July 1, 2022.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022
LIC809 (FAS) - (06/04)
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