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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010571
Report Date: 08/30/2024
Date Signed: 08/30/2024 10:10:24 AM

Document Has Been Signed on 08/30/2024 10:10 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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:AGUILAR, MARICRUZ & MENERA, JUAN FCCHFACILITY NUMBER:
493010571
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
08/30/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:25 AM
MET WITH:Maricruz AguilarTIME VISIT/
INSPECTION COMPLETED:
10:25 AM
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An unannounced case management inspection was conducted today by Licensing Program Analyst (LPA), Amy Strother. LPA met with Licensee, Maricruz Aguilar (L1). The visit was in response to an Unusual Incident/Injury Report (UIR) received by the Department on 08/13/24.

During today’s inspection, the facility was toured and UIR report reviewed. LPA observed 4 children in care, being supervised by Licensee (L1). Licensee, Juan Menera (L2) was present in the home during the visit, working in the kitchen.

During the visit LPA discussed the topic of supervision with L1 and shared a link to the video titled, “Supervising Children in Family Child Care” from the collection of resource videos for Family Child Care Providers on the CDSS website. https://ccld.childcarevideos.org/family-child-care-providers/supervising-children-in-family-child-care/

The Unusual Incident/Injury Report submitted on 08/13/24 was received on form LIC624, which is a form designated for Child Care Center use. LPA discussed Unusual Incident Report procedures with L1, to include reviewing and providing form LIC624B to L1, which is the form designated for Unusual Incident/Injury Report for Family Child Care Homes.

There were no Title 22 deficiencies cited during today's inspection.

A notice of site visit was given to licensee and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted and report was reviewed with the licensee, Maricruz Aguilar.

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE: DATE: 08/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2024
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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