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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173010786
Report Date: 12/09/2024
Date Signed: 12/09/2024 12:15:56 PM

Document Has Been Signed on 12/09/2024 12:15 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:MCBRAYER, MICHELLE FCCHFACILITY NUMBER:
173010786
ADMINISTRATOR/
DIRECTOR:		MICHELLE MCBRAYERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 350-5345
CITY:CLEARLAKESTATE: CAZIP CODE:
95422
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
12/09/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Michelle McBrayerTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Sebastian Phouthavong arrived to conduct a change of location prelicensing inspection. An application was received to the department on 10/31/2024 for the change of location. An approved fire clearance was conducted 12/06/2024. Services will be available Monday - Sunday, 6:00 AM - 11:59 PM. The licensee understands that 24hr consecutive care is prohibited. There are 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 tv room, playroom, kitchen, dining room, living room and one of the hallway bathrooms. The off-limits areas includes the laundry room, master bedroom with bathroom, the other hallway bathroom, garage and entire 2nd floor including 2 bedrooms and backyard. The off-limits areas of the home will be inaccessible by door locks, plastic doorknob covers and/or child gates.

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 to have no firearms or any other dangerous weapons in the home and any were observed during today's inspection. LPA observed the fireplace to be screened/barricaded. There is a functioning smoke detector and carbon monoxide detector in the home. 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 is swimming pool located in off limits backyard with pool cover on top & nailed to the ground. Additionally a hot tub also located in the backyard with cover on top. Both bodies of water were inaccessible to daycare children during this time of inspection.

The request for a relocation has been met and will be approved, effective today's date, 12/09/2024

Additionally the facility currently has a status of probationary license transferring from the 173008720 License. The facility shall compliance with the terms of the Stipulation or Decision and Order; effective on 05/31/2024. Please contacted the Santa Rosa Regional Office for more information.

Exit interview conducted and report was reviewed with the Licensee, Michelle McBrayer.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE: DATE: 12/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/09/2024
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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