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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483010329
Report Date: 01/31/2024
Date Signed: 01/31/2024 03:31:25 PM

Document Has Been Signed on 01/31/2024 03:31 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 CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:DEBOSE-MCCREE, ANTHONYFACILITY NUMBER:
483010329
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
01/31/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:22 PM
MET WITH:Anthony Debose-MccreeTIME COMPLETED:
03:45 PM
NARRATIVE
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On 01/31/23 at 12:22pm, a Case Management visit was conducted by Licensing Program Analysts (LPAs) Cindy Castro and Mel Augustin, and LPAs met with licensee Anthony Debose-Mccree (LS). Purpose of visit was to evaluate facility's emergency readiness preparedness.

Upon Arrival, LPAs conducted a headcount and 5 children were being cared and supervised by licensee and staff. LPAs noticed that the Emergency Disaster Plan (LIC610A) was posted on the parent board. Licensee said that he conducted a fire drill within 6 months,last drill was documented on 12/01/23. LS stated that hours of operation are Monday-Thursday 7:00AM-4:30PM. LS confirmed that some children are also enrolled at another licensed facility near by and received care in case of an emergency situation or when LS facility is closed. LPAs requested facility roster of children in care and reviewed 14 children's (C1-C14) records which revealed C2-C3's Immunization Records were not up to date, as well as C2-C13 were missing Licensing form 282.

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 to licensee and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.Exit interview conducted and report was reviewed with the licensee Anthony Debose-Mccree.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Cindy Castro
LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2024
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 01/31/2024 03:31 PM - It Cannot Be Edited


Created By: Cindy Castro On 01/31/2024 at 02:56 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: DEBOSE-MCCREE, ANTHONY
FACILITY NUMBER: 483010329

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/31/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/10/2024
Section Cited
CCR
102417(m)(3)

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The licensee or registrant shall maintain one of the following:A file of affidavits signed by each parent with a child enrolled in the home. The affidavit shall state that the parent has been informed that the family child care home does not carry liability insurance or a bond according to standards established by the state.
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Licensee stated that he would provide LIC282 to parents/guardians and obtain signatures and provide signed copies of forms to the department by: 02/10/2024
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This requirement was not met as evidenced by: Based on records reviewed at 1:16pm, which revealed C2-C13 were missing LIC 282. This poses a potential health, safety and or personal rights risk to the children in care.
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Via email, fax or mail. Email:cindy.castro@dss.ca.gov
Type B
01/31/2024
Section Cited
CCR102418(a)

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Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.
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Licensee stated that they would obtain updated records from parents/guardians of C2-C3 and provide copies to the Department by:02/10/24
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This requirement was not met as evidenced by: Based on records reviewed at 1:16pm, which revealed C2-C3 were missing update immunization records on file.
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Via email, fax or mail. Email:cindy.castro@dss.ca.gov
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:Alexis Hollon
LICENSING EVALUATOR NAME:Cindy Castro
LICENSING EVALUATOR SIGNATURE:
DATE: 01/31/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/31/2024


LIC809 (FAS) - (06/04)
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