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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173009814
Report Date: 10/08/2021
Date Signed: 10/08/2021 11:11:36 AM

Document Has Been Signed on 10/08/2021 11:11 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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:SERTICH, MARCY FCCHFACILITY NUMBER:
173009814
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 3DATE:
10/08/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Marcy SertichTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Glenn Ouye met with licensee Marcy Sertich to conduct a capacity increase inspection. The capacity increase application was received on October 4, 2021.
LPA Ouye verified that the home has a functioning smoke and carbon monoxide detector and fully charged fire extinguisher. The facility has a wood stove in the living room that has a barricade making it inaccessible to the children in care.

LPA and licensee also discussed capacity limits, child to adult ratio and safe sleep regulation. LPA left copies of safe sleep regulations and handouts with the licensee.

The facility is approved as a large family child care home effective today, 10/8/2021.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 10/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/08/2021
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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