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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173010444
Report Date: 07/17/2024
Date Signed: 07/17/2024 02:26:08 PM

Document Has Been Signed on 07/17/2024 02:26 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:HERNANDEZ, NORMA FCCHFACILITY NUMBER:
173010444
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 5CENSUS: 8DATE:
07/17/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:51 PM
MET WITH: Norma HernandezTIME VISIT/
INSPECTION COMPLETED:
02:35 PM
NARRATIVE
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An inspection was conducted at the facility by Licensing Program Analysts, Sebastian Phouthavong. LPA met with Licensee, Norma Hernandez. During the inspection the home was toured inside and outside. The licensee was supervising eight children and operating within the licensed capacity and ratio requirements. From an interview, Licensee admitted to having the upper platform in front of the facility's entrance door available to daycare children and allowed children to be in the area. Furthermore, Licensee stated that was during a previous time and that the Licensee would supervise the children when on the platform. LPA observed the platform to be accessible to the stairs leading to the lower floor and open to the public area, which is unsafe for the daycare children. In addition, one child’s statement stated children were allowed to be in the platform with the Licensee’s supervision.

The following violation(s) of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Appeal Rights were provided.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee, Norma Hernandez.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE: DATE: 07/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/17/2024
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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Document Has Been Signed on 07/17/2024 02:26 PM - It Cannot Be Edited


Created By: Sebastian Phouthavong On 07/17/2024 at 12:49 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: HERNANDEZ, NORMA FCCH
FACILITY NUMBER: 173010444

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/31/2024
Section Cited
CCR
102423(a)(2)

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102423(a)(2)(a) Personal Rights: Each child receiving services from a family child care home shall have certain rights...These rights include, but are not limited... (2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.
This requirement is not met as evidenced by:
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LPA provided the Regulation 102423(a)(2)(a). Licensee stated she will review the requirements & submit a statement on her understanding of the requirements & that she will no longer allow the daycare children to be on the platform with Licensee's signature.
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Based on observation and interview the licensee allowed daycare children to be on upper platform having the lower floor and public area available to daycare children, which poses a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Leslie Lepori
LICENSING EVALUATOR NAME:Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE:
DATE: 07/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/17/2024


LIC809 (FAS) - (06/04)
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