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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010678
Report Date: 07/22/2024
Date Signed: 07/25/2024 09:27:22 AM

Document Has Been Signed on 07/25/2024 09:27 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 RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:VANSLAMBROUCK, LILIA FCCHFACILITY NUMBER:
493010678
ADMINISTRATOR/
DIRECTOR:		VANSLAMBROUCK, LILIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 494-5724
CITY:GRATONSTATE: CAZIP CODE:
95444
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
07/22/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Lilia VanSlambrouckTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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A pre-licensing inspection was conducted today by Licensing Program Analyst (LPA) Mindy Mohr. The applicant, Lilia VanSlambrouck is requesting a license for a capacity of 14 children. Child Care Services will be available Monday through Friday 8:30am – 4:30pm. The applicant understands that 24-hour consecutive care is prohibited. The home is a 3 bedroom/1 bath two story home. There are two adults living in the home. Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

The floor and yard plans were verified. The second level of the home includes one bedroom. The children will have access to the living room, dining room, one bedroom, kitchen, laundry room and bathroom. The off-limits areas of the home include two bedrooms, one bedroom is on the second level, both are made inaccessible by a child safety gate. The home appears to be clean and orderly at this time and will remain so during childcare hours.

There is a working telephone in the home. The sharp knives, cleaning supplies, and medicines, are stored out of the reach of children. The applicant states there are no guns or dangerous weapons in the home and none were observed. Applicant states there are no poisons in the home, and none were observed during today's inspection. The requirement that poisons be stored in a space locked with a key lock/combination lock was reviewed. LPA observed safe toys and equipment available for children. The home is equipped with a working smoke detector and carbon monoxide detector. There is no spa, pool, pond, or fountain on the premises. None shall be added without prior approval of the Licensing agency.

(Continued on LIC809-C)

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melinda Mohr
LICENSING EVALUATOR SIGNATURE: DATE: 07/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/23/2024
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: VANSLAMBROUCK, LILIA FCCH
FACILITY NUMBER: 493010678
VISIT DATE: 07/22/2024
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The roster is to remain current at all times. LPA reviewed with applicant the LIC 311D, Forms/Records to Keep In Your Family Child Care Home, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant. Unusual Incident Report procedures were explained, to include notification before close of next business day and follow-up with written report to: cclrpregionalofficegeneral@dss.ca.gov within seven days. The applicant will maintain current pediatric CPR, First Aid, and child abuse mandated reporter training certifications. The applicant shall be present in the home and shall ensure that children in care are supervised by a fingerprinted adult with current pediatric CPR and First Aid certification. The applicant understands that children may only be transported by adults with a criminal record clearance and are never to be left unattended in a vehicle. Infants and children shall not be allowed to sleep in car carriers in the home. The applicant clearly understands 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. The applicant understands that all children under age 10 are included in the ratio. Smoking is prohibited at all times in any area where childcare is provided. The applicant understands the responsibility to read and have knowledge of the laws and regulations for operation of a family childcare home. Forms and regulations must be obtained from the website http://ccld.ca.gov/. The applicant understands that any authorized employee of the Department may enter and inspect the facility with or without advance notice.

The applicant provided proof of control of property.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514- 0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

(Continued on LIC809-C)

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melinda Mohr
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024
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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: VANSLAMBROUCK, LILIA FCCH
FACILITY NUMBER: 493010678
VISIT DATE: 07/22/2024
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LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep, as an additional resource. LPA also informed applicant of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: https://www.cpsc.gov/, and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

On this date, 06/07/2024, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Any proposed changes to the physical plant, telephone number, or change of address shall be immediately reported to the Department.

Exit interview conducted and report was reviewed with applicant, Lilia VanSlambrouck.

The following shall be addressed before a Large FCCH license is issued:

· Applicant must obtain a fire extinguisher rated at least 2A10BC.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melinda Mohr
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024
LIC809 (FAS) - (06/04)
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