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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483010654
Report Date: 05/01/2024
Date Signed: 05/01/2024 08:45:24 AM

Document Has Been Signed on 05/01/2024 08:45 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:KROLL, MELISSA FCCHFACILITY NUMBER:
483010654
ADMINISTRATOR/
DIRECTOR:
FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 5CENSUS: 0DATE:
05/01/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:15 AM
MET WITH:Melissa Kroll - ApplicantTIME VISIT/
INSPECTION COMPLETED:
08:55 AM
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Licensing Program Analyst (LPA), Melchisedeck Augustin conducted a follow up Pre-Licensing Inspection and met with applicant, Melissa Kroll to evaluate the home's compliance with pool fencing requirements. During today's inspection, LPA observed an in-ground swimming pool in the backyard. The pool was surrounded by a portable mesh fence that was at least five feet in height, the view of the fence was un-obscured and the gate of the pool swung away from the body of water, and the fence sections and posts were sturdy, however; the far left side of the fence required additional reinforcement.

Additionally, LPA observed a fully charged fire extinguisher which met with state fire marshal standards, and the applicant submitted a copy of her completed Landlord Notification (LIC 9151). According to the applicant, the her landlord did not provide her with consent to operate with up to 8 children. The applicant has not obtained a signed Property Owner/Landlord Consent form (LIC9149). Without this consent, the applicant understands that, once licensed, they can operate with a maximum capacity of 6 children. If property owner/landlord consent is obtained in the future, the applicant is advised that a new Application for a Family Child Care Home License (LIC 279) must be submitted with a change of capacity fee of $25, to increase the capacity and provide care to 8 children.

The license is pending and the following items are required to be corrected prior to issuance of a small Family Child Care Home (FCCH) license.

1. One adult is required to obtain a department approved criminal record clearance.

2. Submit evidence of negative TB clearance for one adult.

3. Submit evidence showing the mesh pool fence is secured and sturdy.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE: DATE: 05/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/01/2024
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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