Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493007074
Report Date: 04/07/2017
Date Signed 04/07/2017 01:39:44 PM

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:SERRANO, MARIA FCCHFACILITY NUMBER:
493007074
ADMINISTRATOR:SERRANO, MARIA FCCHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 293-4911
CITY:SANTA ROSASTATE: CAZIP CODE:
95407
CAPACITY:14CENSUS: 4DATE:
04/07/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:55 AM
MET WITH:Maria SerranoTIME COMPLETED:
01:45 PM
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LPA Leticia Rosales-Meza conducted an Annual/Random visit today. Present are two infants, two older day care children ages 2, and Licensee's son and daughter. A review of the Facility Personnel Report Summary indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances. The facility is toured inside and outside. Services are provided Monday - Friday 7:00 AM-5:00 PM. The main child care areas includes the living room, kitchen, dining room, both downstairs bathrooms, and bedroom #3 for napping. Interior "off limits" areas is the second story of the home and downstairs bedrooms #1 and #2. Access is prevented by door knob covers and a gate is located at the bottom of the stairs. Flex locks are used on the lower cabinet doors in the kitchen and bathrooms to prevent access to toxins. The back side yard is used for play and is fenced. Exterior "off limits" area includes the front yard, right side yard, and the detached garage. There is a gate to prevent access to the side yard and the door is latched. The children's bathroom is free of toxins. There is a working telephone in the home. Family pet is a Chihuahua named, "Mini". Licensee states the dog's shot records are current. Items which could pose a danger to children (detergents, cleaning compounds, and medications) were stored out of the reach of children. Licensee states there are no firearms in the home and none were seen during this visit. Poisons are stored in the detached garage outside using a key lock. There is a working smoke detector, carbon monoxide detector and fire extinguisher in the home. The licensee has completed the training on preventative health practices as required. CPR and First Aid cards expire 03/2019. Children files are reviewed and complete. The facility roster is current and complete. Emergency drills are to be conducted and documented two times a year. The most recent drill was conducted on January 9, 2017. There are no bodies of water located on the property. The home is heated and cooled by a central unit. The home appears clean and orderly, with heating and ventilation for safety and comfort. There is a large variety of toys and furnishings for the children to use inside and outside. All licensing reports are public information and must be made available upon request for at least three years. Plan of Operations for IMS (Incidental Medical Service) was discussed. At this time the facility does not provide Incidental Medical Services-IMS. LPA consulted regarding the new Immunization Requirements 2016 for providers and assistants.

There are 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: Leticia RosalesTELEPHONE: (707) 588-5061
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2017
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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