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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483010398
Report Date: 04/21/2023
Date Signed: 04/21/2023 10:53:50 AM

Document Has Been Signed on 04/21/2023 10:53 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:ROGERS, ANDREA FCCHFACILITY NUMBER:
483010398
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
04/21/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Andrea RogersTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Glenn Ouye conducted a change of location visit. The licensee has also requested a capacity increase. The application was received on March 29, 2023.

The home is a four bedroom/two and a half bathroom, two story home. The licensee has yet to install the pull station alarm but she will have the Suisun City Fire Inspector return for a reinspection when completed as a requirement of a large FCCH. LPA Ouye will return to conduct the capacity increase after the approved fire clearance has been received.

The on limits area of the home are the living room, a down stairs bedroom, the downstairs half bathroom and the kitchen. The garage is off limits and the entire upstairs of the home is off limits. The upstairs off limit area is made inaccessible with a child safety gate and the garage is made off limits with a door knob cover. There is a working telephone in the home. The sharp knives, cleaning supplies, medicines, will be stored out of the reach of children. There were no firearms and ammunition in the home at the time of this inspection. Licensee states the poisons on site will be stored in a locked container. The regulation that poisons are to be locked using a key or combination lock was reviewed. First Aid supplies will be maintained at the facility. The children in care will have access to age appropriate toys and equipment. The home is equipped with a working smoke detector, carbon monoxide detector and a fire extinguisher rated at 3A40BC. The home's fireplace is strapped closed and will not be used during child care hours. The home's backyard is fully fenced and part of it will be used for childcare. The right side of the backyard is off-limits and gated. There is no spa, pool, pond, or fountain on the premises. None shall be added without prior approval of the Licensing agency.

The licensee will send LPA Ouye photos of the locking container for poisons and the strapped fire place. Upon receipt of the photos the facility will be approved for licensure.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 04/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/21/2023
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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