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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483010329
Report Date: 12/04/2024
Date Signed: 12/04/2024 11:08:34 AM

Document Has Been Signed on 12/04/2024 11:08 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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:DEBOSE-MCCREE, ANTHONYFACILITY NUMBER:
483010329
ADMINISTRATOR/
DIRECTOR:		DEBOSE-MCCREE, ANTHONYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 280-4737
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
12/04/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:07 AM
MET WITH:Anthony Debose-MccreeTIME VISIT/
INSPECTION COMPLETED:
11:20 AM
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On 12/04/24 Licensing Program Analyst (LPA), Cindy Castro arrived to conduct an unannounced case management visit- other. LPA met with Anthony Debose-Mccree, Licensee (L1). Today’s census is 6 children care for and supervised by L1 and Staff (S1-S2).

During today’s visit LPA C. Castro, reviewed with licensee Type A deficiency citation requirements, including Acknowledgement of Receipt of Licensing Reports LIC9224 or other written statement placed in the child’s file for verification. Time frames were reviewed to notify Parent/Guardians of all current children enrolled within a business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of when a Type A deficiency is cited.

LPA C. Castro reviewed records during today’s visit and confirmed that Children's Roster was current and all children currently enrolled had a signed LIC9224 form by Parent/Guardian within the time frames required. Due to fact that L1 was not present at facility inspection during a Type A citation on 11/19/24. LPA C. Cindy Castro also informed L1 that Type A citation(s) issued shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care. LPA observed that Notice of site visit was posted and L1 also had a copy of the Facility Evaluation Report dated 11/19/24 posted. L1 stated that he understood Type A deficiency requirements.

Also a review of Unusual Incident Report (UIR) procedures was conducted with L1, to include notification before close of next business day and follow-up with written report within seven days. L1 stated that he understood the UIR procedures.

There were no Title 22 deficiencies cited during today's inspection.

This report was reviewed with licensee Anthony Debose-Mccree and was provided.

SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Cindy Castro
LICENSING EVALUATOR SIGNATURE: DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/04/2024
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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