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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010232
Report Date: 10/25/2023
Date Signed: 10/25/2023 11:20:17 AM

Document Has Been Signed on 10/25/2023 11:20 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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:MALDONADO, SUSANA & MIRANDA, NOEMI FCCHFACILITY NUMBER:
493010232
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
10/25/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Susana "Susie" Maldonado & Noemi Miranda TIME COMPLETED:
11:30 AM
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A case management inspection was conducted to the facility by Licensing Program (LPA) Amy Strother in response to an increase capacity application received by the Department on 09/12/2023 from Licensees, Susana "Susie" Maldonado and Noemi Miranda (L1 & L2). The licensees are requesting a capacity of 14. The licensees stated they clearly understand the maximum number of children for whom care can be provided and the limitations on the number of infants (birth to age 2) that may be cared for and when two of the children in care must be school aged, and when an assistant provider must be present. 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. The facility was toured inside and outside and files reviewed during a 1-year required inspection of the facility on today’s date 10/25/23. The facility’s operating hours are 06:00am - 11:30pm, Monday - Friday.

L1 & L2’s Pediatric CPR and Pediatric First Aid cards expire 04/2024. There is a functional smoke/carbon monoxide detector and a charged fire extinguisher in the facility. The fire pull station is located in the homes entry, labelled "kids play room" on the facility sketch. The Santa Rosa Fire Department inspected and granted a fire clearance on 09/27/2023, and was emailed to LPA Strother on 10/18/23.

The increase capacity to 14, as a Large Family Child Care Home is granted as of today, 10/25/2023.

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.

Exit interview conducted and report was reviewed with the licensees, Susana Maldonado and Noemi Miranda .

There were no Title 22 deficiencies cited during today's inspection.

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE: DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/25/2023
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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