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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010018
Report Date: 11/22/2022
Date Signed: 11/22/2022 09:45:25 AM

Document Has Been Signed on 11/22/2022 09:45 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:DURGIN, DEBRA FCCHFACILITY NUMBER:
493010018
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
11/22/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Debra DurginTIME COMPLETED:
09:15 AM
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An informal meeting was held today by telephone with the licensee Debra Durgin, Licensing Program Manager (LPM) A. Hollon, and Licensing Program Analyst (LPA) Y.Yang in regards to an absence of supervision incident that occurred on 11/01/22. The licensee stated that a child was without staff supervision for approximately 15 minutes while on a walk outside of the facility.

The licensee notified the LPA and CCLD by telephone on 11/01/2022 and an Unusual Incident Report (UIR) by was received by the Department on 11/01/2022.

As a result of this incident, the facility is on increased monitoring (two required visits per year).
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Yang Yang
LICENSING EVALUATOR SIGNATURE: DATE: 11/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2022
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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