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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483010321
Report Date: 03/03/2023
Date Signed: 03/03/2023 09:06:45 AM

Document Has Been Signed on 03/03/2023 09:06 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:KELLY, BRIDGET FCCHFACILITY NUMBER:
483010321
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
03/03/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Bridget KellyTIME COMPLETED:
09:30 AM
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Licensing Program Analyst (LPA) Glenn Ouye met with licensee Bridget Kelly to conduct a capacity increase for her family child care home. The capacity increase application was received on February 9, 2023. The fire safety inspection was approved on February 27, 2023. The licensee is qualified as a large FCCH provider based on her experience as a teacher in a licensed preschool.

The facility has functioning smoke and carbon monoxide detectors and a fire extinguisher rate at least 2A10BC.

Capacity and child ratio for a large FCCH was discussed with the licensee.

The facility is approved as a large family child care home effective March 3, 2023.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 03/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/03/2023
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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