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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010737
Report Date: 08/26/2024
Date Signed: 08/26/2024 05:01:30 PM

Document Has Been Signed on 08/26/2024 05:01 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:MAGADAN GUTIERREZ, LORENA FCCHFACILITY NUMBER:
493010737
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
08/26/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:10 PM
MET WITH:Lorena Magadan GutierrezTIME VISIT/
INSPECTION COMPLETED:
05:15 PM
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A change of location pre-licensing inspection was conducted today by Licensing Program Analyst (LPA) Leticia Rosales-Meza. The applicant is Spanish Speaking. The applicant was previously licensed at 600 Rodeo Ln., Apt. 224 Santa Rosa, CA 95407. The licensee is requesting a license for a capacity of 8 children. Services will be available Monday through Friday, 6:00 AM-11:59 PM. The licensee understands that 24hr consecutive care is prohibited. The residence is a two bedroom one bathroom, two story level apartment complex. There is currently one adult living in the home.

During the inspection the home was toured inside and outside. The floor plan submitted by the licensee was reviewed and verified. The children will have access to the living room, and will use the bathroom upstairs (no bathroom downstairs). The children will be escorted to the bathroom upstairs as needed. The off-limits areas of the home are the two bedrooms upstairs, and were made inaccessible by plastic door knob slip covers and two secured safety gates, one at the top of stairs and one at the bottom. The children will use the backyard as outdoor play area.

The Licensee stated there are no poisons in the home and the regulation that poisons are to be locked using a key or combination lock was reviewed. Licensee stated there are no firearms and any other dangerous weapons in the home and none were observed during today's inspection. The sharp knives, cleaning supplies, medicines will be stored out of reach of children. There is a functioning smoke detector and carbon monoxide detector. The fire extinguisher is rated at 2A10BC. First aid supplies will maintained at the facility at all times. The home's yard is fully fenced. There were no pools or other bodies of water observed.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.

Continued on LIC 809-C

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Leticia Rosales
LICENSING EVALUATOR SIGNATURE: DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2024
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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: MAGADAN GUTIERREZ, LORENA FCCH
FACILITY NUMBER: 493010737
VISIT DATE: 08/26/2024
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 The Licensee will maintain current on Pediatric CPR and First Aid. CPR and First Aid cards expire 9/2025. The Licensee shall be present in the home and shall ensure that children in care are supervised by a fingerprinted adult with current Pediatric CPR and First Aid certification.

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/.


Exit interview conducted and report was reviewed with the Licensee, Lorena Magadan Gutierrez

Any proposed changes to the physical plant, telephone number, or change of address shall be immediately reported to the Department.




This facility is approved for a small FCCH license effective today's date, August 26, 2024.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Leticia Rosales
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024
LIC809 (FAS) - (06/04)
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