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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483010069
Report Date: 05/17/2023
Date Signed: 05/17/2023 03:01:40 PM

Document Has Been Signed on 05/17/2023 03:01 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:FELDER, REGINAFACILITY NUMBER:
483010069
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 8DATE:
05/17/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Regina FelderTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Glenn Ouye met with licensee Regina Felder to complete a capacity increase case management visit. An approved fire clearance was received by the department on May 15, 2023. A copy of the approved fire clearance was emailed to the licensee on May 17, 2023.

There are functioning carbon monoxide and smoke detectors. The pull station alarm is mounted on the wall in the living room. There is a fire extinguisher rated at least 2A10BC in the kithcen.

The capacity increase from a small to large FCCH is approved effective May 17, 2023. A new license will be sent to the licensee.

No deficiencies noted during the inspection.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/17/2023
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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