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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493009653
Report Date: 03/17/2021
Date Signed: 03/17/2021 03:37:15 PM

Document Has Been Signed on 03/17/2021 03:37 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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:SHEETS-STEWART, KRISTINE FCCHFACILITY NUMBER:
493009653
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
03/17/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Kristine Sheets-StewartTIME COMPLETED:
03:04 PM
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A tele visit inspection was conducted today by Licensing Program Analyst (LPA) Y. Yang in response to an increase capacity application received by the Department. Due to the COVID-19 pandemic, a tele-visit inspection was conducted in place of an in-person, site visit. The licensee is requesting a capacity of 14. The licensee has met the required experience for a large family child care home. The approved fire clearance was received on 03/15/21 for the requested capacity. There is a waiver on file for the facility. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. There are presently two adults living in the home. The home's kitchen, attached garage, living room, mudroom, "bathroom 2", and "bedroom 1" are on limits. The home's second level, "bedroom 2", and hallway "bathroom 1" are off limits. Licensee stated she understands that off-limits areas will need to be made inaccessible at all times during child care hours. The home's electric fireplace is barricaded. The children will use the home's backyard, front yard, barn, and side yard as the outdoor play area and they are fully fenced. There is a hot tub in the yard with a locked hard cover. As per the conditions of the waiver on file, the licensee states she understands the outdoor play areas shall be supervised by the licensee or caregiver. Licensee stated there are no poisons stored on the premises. Ratios for a large family child care home were reviewed. Items which could pose a danger to children (detergents, cleaning compounds, medications, etc.) were stored out of the reach of children. There is a working smoke detector, carbon monoxide detector, and charged fire extinguisher rated 2A:10B:C in the home. The licensee stated there are no firearms and other dangerous weapons are stored on the premises.
(Continued on LIC 809-C)
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Yang Yang
LICENSING EVALUATOR SIGNATURE: DATE: 03/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/17/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME: SHEETS-STEWART, KRISTINE FCCH
FACILITY NUMBER: 493009653
VISIT DATE: 03/17/2021
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The licensee is not providing Incidental Medical Services – IMS. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 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,www.ada.gov/childqanda.htm. Infant safe sleep regulations were discussed. All licensing reports are public information and must be made available upon request for at least three years.

The increase of capacity application is granted effective 03/17/21. The report was emailed to the licensee.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Yang Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2021
LIC809 (FAS) - (06/04)
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