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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483006806
Report Date: 08/30/2021
Date Signed: 08/31/2021 10:41:53 AM

Document Has Been Signed on 08/31/2021 10:41 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:MOREHEAD, LORI FAMILY CHILD CARE HOMEFACILITY NUMBER:
483006806
ADMINISTRATOR:MOREHEAD, LORIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 864-1219
CITY:FAIRFIELDSTATE: CAZIP CODE:
94534
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 7DATE:
08/30/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:16 PM
MET WITH:Lori MoreheadTIME COMPLETED:
03:32 PM
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An unannounced annual required inspection was made to the facility by Licensing Program Analyst (LPA), Y. Yang. A review of staff records on 08/30/2021 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. There are currently two adults living in the home.

During today’s inspection the home and grounds were toured. There were six children present at the facility. The facility’s operating hours are 07:30am to 05:30pm, Mon–Fri. The floor plan submitted by the licensee was reviewed and verified. The off-limits areas of the home are the entire upstairs floor and the downstairs guest bedroom. These areas were made inaccessible by child gates and/or door knob covers. The home was observed to be clean and orderly, and was at a comfortable indoor temperature. There were safe toys and equipment available for children. The licensee stated there is a working telephone in the home. The licensee’s pediatric CPR and First Aid certification was reviewed and expire in March 2022. Items which could pose a danger to children (such as detergents, cleaning compounds, medications, etc.) were observed to be stored out of the reach of children. Poisons are stored in a key locked shed in the home's backyard. The LPA observed a working smoke detector, carbon monoxide detector and fire extinguisher, rated at least 2A10BC, in the home. The roster of children in care was reviewed and was current. The licensee stated that firearms and ammunition are not stored on the premises. The children use the home’s backyard as the outdoor play area. It is fully fenced and there were no bodies of water observed. Four children's records were reviewed at 02:17pm; Immunization records and children's emergency contact information sheets were reviewed. Infant safe sleep check logs and the infant safe sleep plan were discussed with the licensee. Two staff records were reviewed at 02:45pm. Staff immunization records were reviewed and in compliance. Continued on LIC 809-C
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Yang Yang
LICENSING EVALUATOR SIGNATURE: DATE: 08/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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: MOREHEAD, LORI FAMILY CHILD CARE HOME
FACILITY NUMBER: 483006806
VISIT DATE: 08/30/2021
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The licensee currently does not have any children in care requiring Incidental Medical Services (IMS). The Department's Incidental Medical Services (IMS) policy was discussed with the licensee. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, an IMS plan of operation must be submitted to the Department.

The following information regarding ADA was provided: US Department of Justice toll-free ADA Line at (800) 514-0301 (voice)/(800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, www.ada.gov/childqanda.htm. This report, as well as the AAP Guide to Safe Sleep Practices and COVID guidelines and best practices, and infant safe sleep regulations and best practices were reviewed and discussed with the licensee.

Notice of Site Visit shall be posted for 30 days from today's visit.

There were no Title 22 deficiencies cited during today's inspection.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Yang Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2021
LIC809 (FAS) - (06/04)
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