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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483010739
Report Date: 11/07/2024
Date Signed: 11/07/2024 03:43:16 PM

Document Has Been Signed on 11/07/2024 03:43 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:FARFAN, EDITH FCCHFACILITY NUMBER:
483010739
ADMINISTRATOR/
DIRECTOR:
FARFAN, EDITHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 720-8550
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
11/07/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:56 PM
MET WITH:Licensee Edith FarfanTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Elpidia Hernandez Torres arrived to the Family child care home (FCCH) on 11/07/24 to conduct a case management visit as a result of an Non-Compliance Conference held on 07/31/2024. Upon LPA's arrival there were 7 children present (C1-C7), files for all children present were reviewed at 1:18PM. While LPA was reviewing files, two children (C5 and C6) were picked up there were 5 children left. At 2:55PM 5 children arrived making the total children present 10.

Licensee's day care hours are 04:00AM- 12:30AM M-F. Currently no children stay for over night care.

The technical support program (TSP) previously reached out to the FCCH on 10/01/2024, FCCH declined participation in the program. LPA asked Licensee if there was a reason the FCCH did not want to participate in the program, licensee reported they don't remember speaking to a representative from the TSP, but perhaps her spouse answered the call and declined TSP thinking it was an advertisement for some thing else. Licensee asked if the program was required, LPA replied no, program participation isn't required but can be beneficial for providers to have a better understanding of regulations.

While at the facility LPA reviewed licensee's facility roster LIC 9040 which showed 14 children enrolled in the day. The LIC 9040 is complete and in compliance.

After reviewing C1-C7 files, the only item that needs to be corrected is the LIC 700 emergency card missing guardian's signature on 2 children's files. Before LPA left Licensee's assistant had the files set aside and ready for guardian to sign at pick up.

No deficiencies were issued during todays visit. Notice of site visit was issued and must remain posted for 30 days.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2024
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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