493008699-12-5-2024-01-CC-ASTR-DBNS48-20241205123219

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 493008699
Report Date: 12/05/2024
Date Signed: 12/05/2024 12:32:32 PM

Document Has Been Signed on 12/05/2024 12:32 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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME:	SPAIN, TRACI FCCH		FACILITY NUMBER:	493008699
ADMINISTRATOR/ DIRECTOR:	SPAIN, TRACI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(707) 814-5758
CITY:	CLOVERDALE	STATE: CA	ZIP CODE:	95425
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 8	DATE:	12/05/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:40 AM
MET WITH:	Traci Spain		TIME VISIT/ INSPECTION COMPLETED:	12:47 PM

NARRATIVE

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An annual/random inspection was made to the facility by Licensing Program Analyst (LPA), Amy Strother. LPA met with Licensee, Traci Spain (L1). L1 was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

During the inspection the home was toured inside and outside. During today’s visit L1 was supervising 8 preschool children (C1-C8), all over the age of 2 years, without an assistant present, operating beyond the licensed capacity and ratio requirements. Based on interview, L1 stated that her assistant is sick today, and L1 didn't realize she wasn't coming in until the same time the last children were dropped off. The facility’s operating hours are Monday, Wednesday & Friday 8:00am - 1:00pm and Tuesday & Thursday 8:00am- 4:00pm. L1 provided a current roster of children in care as required. LPA verified that the children present were listed on the roster. The floor plan submitted by the licensee was reviewed and verified. The home's master bedroom and bathroom are off-limits and made inaccessible by a doorknob cover. The home was observed to be clean and orderly and was at a comfortable indoor temperature. There were safe toys and equipment available for children. There is a working telephone in the home. Items which could pose a danger to children (such as detergents, cleaning compounds, medications, etc.) were observed to be stored out of the reach of children. Licensee stated that no poisons are stored on the premises and none were observed during today's inspection. The facility's family room has a gas fireplace which is barricaded with a child safety gate. LPA observed a working smoke detector, carbon monoxide detector and a fire extinguisher that appeared to charged and rated at least 2A10BC, in the home. The licensee has conducted an emergency drill within the past six months; last drill was documented on 10/10/24. The licensee stated there are no firearms and/or other dangerous weapons in the home and none were observed during today's inspection.

Continued on LIC 809-C

SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE:	DATE: 11/14/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024

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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Document Has Been Signed on 12/05/2024 12:32 PM - It Cannot Be Edited

Created By: Amy Strother On 12/05/2024 at 11:32 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: SPAIN, TRACI FCCH	FACILITY NUMBER: 493008699
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/05/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416.5(e)

Staffing Ratio and Capacity

(e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above. Upon LPA's arrival the Licensee was supervising 8 preschool children over the age of 2 years old without an assistant present, two more children than regulation allows, unless the two additional children are at least 6 years old or enrolled and attending TK or above. Based on the ages of the children, the Licensee was operating over capacity, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/06/2024
	Plan of Correction
1 2 3 4	Licensee stated she will submit a written procedure stating how she will prevent being over capacity in the future.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Megan Aviles

LICENSING EVALUATOR NAME:

Amy Strother

LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: SPAIN, TRACI FCCH	FACILITY NUMBER: 493008699
	VISIT DATE: 12/05/2024

NARRATIVE

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PAGE 2

The children use the backyard as the outdoor play area, the back yard has a swing gate that leads to the front yard where it is not fully fenced. Licensee understands that she must supervised children at all times while using the back yard. There is a hot tub in the backyard, that has a spa cover and is locked on all four sides. Licensee has a waiver dated 12/05/13 for fountain in front yard. Five children's records were reviewed. Facility and personnel files were reviewed and contained required records.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Continue on LIC809-C

SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: SPAIN, TRACI FCCH	FACILITY NUMBER: 493008699
	VISIT DATE: 12/05/2024

NARRATIVE

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The following violation of the California Code of Regulations, Title 22; Division 12, was observed: see LIC 809D. Appeal Rights were provided.

A notice of site visit was given to licensee and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted and report was reviewed with the licensee Traci Spain.

SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024

LIC809 (FAS) - (06/04)

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