Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 490170978
Report Date: 06/19/2017
Date Signed 06/21/2017 09:41:08 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office; CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:VOGT, JODY FAMILY CHILD CARE HOMEFACILITY NUMBER:
490170978
ADMINISTRATOR:VOGT, JODYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 578-0549
CITY:SANTA ROSASTATE: CAZIP CODE:
95405
CAPACITY:14CENSUS: 6DATE:
06/19/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Jody Vogt, LicenseeTIME COMPLETED:
03:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) N. Cunningham conducted an unannounced inspection. During today’s inspection the home and grounds were toured and the licensee was operating within the licensed capacity. Operating hours are 7am to 5:30pm, M – Thurs. and 7am-4:30 on Fri. The floor plan was verified. Off limits areas are inaccessible. There is a working telephone in the home. Items which could pose a danger to children (detergents, cleaning compounds, and medications) were stored out of the reach of children. There is a working carbon monoxide detector, smoke detector and fire extinguisher in the home. The licensee has a current roster of children in care and has conducted an emergency drill within the past six months. LPA consulted on SB792, Child Care Employee and Volunteer Immunization and Tuberculosis Requirements. IMS- Incidental Medical Services were discussed. The licensee stated there are no poisons, firearms and/or other dangerous weapons in the home and none were observed during today's visit. The children use the backyard as the outdoor play area and it is completely fenced. There are no bodies of water on the premises. All licensing reports are public information and must be made available upon request for at least three years. LPA provided information handout on Guide to Safe Sleep, regulation 102418 (Immunization) and Health and Safety 1597.622 information.

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.
There were no Title 22 deficiencies cited during today's visit.
Notice of Site Visit shall be posted for 30 days from today's visit.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Nicolette CunninghamTELEPHONE: 707-588-5058
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2017
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1