<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493009775
Report Date: 12/27/2024
Date Signed: 12/27/2024 03:58:49 PM

Document Has Been Signed on 12/27/2024 03:58 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:DEASON, ANDREA FCCHFACILITY NUMBER:
493009775
ADMINISTRATOR/
DIRECTOR:
DEASON, ANDREAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 328-5086
CITY:ROHNERT PARKSTATE: CAZIP CODE:
94928
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
12/27/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:51 PM
MET WITH:Andrea DeasonTIME VISIT/
INSPECTION COMPLETED:
03:22 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
An unannounced case management visit was made to the facility by Licensing Program Analyst (LPA) Y. Yang in response to a self-reported incident involving child C1 that occurred at the facility on 11/15/24. During today’s visit, the LPA met with the licensee, Andrea Deason to discuss the incident and obtain additional information. It was reported by the licensee that during morning snack time on 11/15/24 at 10:37am, child C1 started presenting with allergy symptoms (rash on body and red face). Licensee stated that C1 was able to take deep breaths, however. Licensee stated that she provides all meals and snacks served at the facility. Licensee stated that C1 has food allergies and was not served or exposed to anything that C1 was allergic to or has not previously consumed at the facility in the past.

Licensee stated that she moved C1 to an area away from the other children and then contacted 911. The licensee stated that while waiting for emergency medical services to arrive on site, the 911 dispatcher instructed her to administer the child’s epinephrine injector, which was located on site. Licensee stated that C1’s authorized representative was notified. Licensee stated that she rode along in the ambulance with C1 and met C1’s authorized representative at the hospital while the licensee’s assistant remained at the facility with the other children in care. Licensee stated that C1 was treated at the hospital and released the same day. Licensee stated that C1’s authorized representative later informed her that additional testing was performed, and they have reason to believe that C1’s allergic reaction was due to environmental reasons rather than food related. Licensee stated that C1's authorized representative supplied the facility with a replacement epinephrine injector.

This incident was reported to Community Care Licensing as required per regulations. There were no Title 22 deficiencies cited during today’s inspection visit. A notice of site visit was given and must remain posted for 30 days. This report was read and reviewed with the licensee, Andrea Deason.

SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Yang Yang
LICENSING EVALUATOR SIGNATURE: DATE: 12/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/27/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1