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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483010397
Report Date: 05/23/2024
Date Signed: 05/23/2024 03:14:59 PM

Document Has Been Signed on 05/23/2024 03:14 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:WILBURN, LATASHA FCCHFACILITY NUMBER:
483010397
ADMINISTRATOR/
DIRECTOR:		WILBURN, LATASHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 439-5048
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
05/23/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:Licensee Latasha WilburnTIME VISIT/
INSPECTION COMPLETED:
03:20 PM
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Licensing Program Analyst ( LPA) Elpidia Hernandez Torres arrived to the Family Child Care Home ( FCCH) on 05/23/2024 to conduct a plan of correction visit. LPA was previously at the facility on 04/02/2024 for an inspection, during that inspection the FCCH was issued a deficiency for licensee and assistant missing AB 1207 Mandated reporter training certificates.

During today visit LPA reviewed licensee and assistant's file. Both Licensee and assistant completed AB 1207 Mandated reporter training certificates on 04/04/2024.

While LPA was present in the home, LPA reviewed safe sleep regulations with licensee and assistant and reminded them of the importance of keeping sleep logs on file for infants (birth- 24 months).

No deficiencies were issued during todays visit. Notice of site visit was given and must remain posted for 30 days. Deficiency previously issued have been cleared as of todays visit.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE: DATE: 05/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2024
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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