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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010130
Report Date: 07/25/2024
Date Signed: 07/25/2024 12:29:10 PM

Document Has Been Signed on 07/25/2024 12:29 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 RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:COLE, CAROL FCCHFACILITY NUMBER:
493010130
ADMINISTRATOR/
DIRECTOR:		COLE, CAROLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 207-2610
CITY:SEBASTOPOLSTATE: CAZIP CODE:
95472
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
07/25/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:05 AM
MET WITH:Carol ColeTIME VISIT/
INSPECTION COMPLETED:
12:43 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
Licensing Program Analyst (LPA), Mindy Mohr made an unannounced Plan of Correction (POC) visit and met with Licensee, Carol Cole (L1), for the purpose of following up on several outstanding POCs that were due by 06/24/2024. During the annual inspection on 06/10/2024, the facility was cited four violations which include L1 and S1 not having completed mandated reporter training certificates, L1 was unable to furnish a pediatric 1st aid / CPR certificate, S1 did not have proof of immunization's and four children’s (C2 – C4 & C6) records were incomplete missing their immunization records.

During today's visit, LPA observed 11 children in care. L1 stated that the children's files are the same as when they were reviewed during the last visit, and that neither herself or S1 completed the mandated reporter training. L1 also stated that S1 does not have proof of her immunization's. S1 stated she will make an appointment immediately for her immunization's. L1 stated that both herself and S1 will take the mandated reporter training by the end of this week. LPA reviewed four children's records (C2 – C4 & C6) and 2 staff (L1 & S1) files which confirmed L1's statement that proof of immunization's were still missing from the children's files, both L1 and S1 were missing their mandated reporter certificates as well as proof of immunization's for S1. During file review LPA did locate L1's pediatric 1st aid / CPR certificate which expires 01/2026.

Exit interview conducted and report was reviewed with the Facility Representative, Carol Cole. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. The following violation of the California Code of Regulations, Title 22, were observed during today’s visit. See LIC809-D. Appeal Rights were provided.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melinda Mohr
LICENSING EVALUATOR SIGNATURE: DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/25/2024
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 3
Document Has Been Signed on 07/25/2024 12:29 PM - It Cannot Be Edited


Created By: Melinda Mohr On 07/25/2024 at 11:47 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: COLE, CAROL FCCH
FACILITY NUMBER: 493010130

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/25/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/01/2024
Section Cited
HSC
1597.622(a)(1)

1
2
3
4
5
6
7
(a) (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
L1 stated that S1 will get proof of her immunizations. L1 will send to melinda.mohr@dss.ca.gov
8
9
10
11
12
13
14
Based on interview and record review, the licensee did not comply with the section cited above in which S1 does not have proof of immunizations, which poses/posed a potential health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14
Type B
08/01/2024
Section Cited
CCR102418(a)

1
2
3
4
5
6
7
(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
 L1 stated she will get the records from the parents, fill out the blue card and email a signed document to LPA Mohr stating that all children's files have immunization records in them to melinda.mohr@dss.ca.gov.
8
9
10
11
12
13
14
Based on record review, the licensee did not comply with the section cited above in which four children's records C2 - C4 and C6 did not have immunizations records which poses/posed a potential health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14
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:Leslie Lepori
LICENSING EVALUATOR NAME:Melinda Mohr
LICENSING EVALUATOR SIGNATURE:
DATE: 07/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/25/2024


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 07/25/2024 12:29 PM - It Cannot Be Edited


Created By: Melinda Mohr On 07/25/2024 at 11:56 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: COLE, CAROL FCCH
FACILITY NUMBER: 493010130

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/25/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/01/2024
Section Cited
HSC
1596.8662(b)(1)

1
2
3
4
5
6
7
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
L1 stated that herself and S1 will complete the mandated reporter training immediately. Licensee will email the certificates to LPA Mohr at melinda.mohr@dss.ca.gov
8
9
10
11
12
13
14
Based on record review, L1 did not comply with the section cited above in which both L1 and S1 did not complete the mandated reporter training, which poses/posed a potential health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Leslie Lepori
LICENSING EVALUATOR NAME:Melinda Mohr
LICENSING EVALUATOR SIGNATURE:
DATE: 07/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/25/2024


LIC809 (FAS) - (06/04)
Page: 3 of 3