480110456-8-15-2023-01-CC-MAUN-CUQP3P-20230815105752

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 480110456
Report Date: 08/15/2023
Date Signed: 08/15/2023 10:58:02 AM

Document Has Been Signed on 08/15/2023 10:58 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:	BOSSON, VALERI J. FCCH		FACILITY NUMBER:	480110456
ADMINISTRATOR:	BOSSON, VALERI J.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(707) 631-3997
CITY:	SUISUN	STATE: CA	ZIP CODE:	94585
CAPACITY: 9	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	08/15/2023
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	08:23 AM
MET WITH:	Valeri Bosson - Licensee		TIME COMPLETED:	11:10 AM

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	A Case Management inspection was made to the facility by Licensing Program Analyst (LPA), Melchisedeck Augustin to evaluate compliance with Title 22. The facility license is currently on inactive status and the Licensee requested for the facility status to be changed to “Licensed”. A review of staff records on 08/15/2023 indicates that all facility staff or other individuals who require caregiver background checks received a criminal record and child abuse index clearances or exemptions. Licensee was reminded that all adults 18 and over living or working in the home, 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. There are currently two adults residing in the home. During today’s inspection the home and grounds were toured. The home is single story residence without a staircase. The Licensee (LS) did not have any children in care, operating within the licensed capacity and ratio requirements. The facility’s operating hours are 5:30 am to 5:30 pm, Mon–Fri. The floor plan submitted by the licensee was reviewed and verified. The off-limits areas of the home are two bedrooms, laundry room and the garage that were accessible. The knobs on the stove in the kitchen were inaccessible. Several electrical wall outlets in the living room and on limit bedroom were accessible. The home indoor temperature was comfortable, however; the carpet was dirty with stains and contained debris. The fireplace was screened with large tote boxes. There are accessible cleaning compounds in a cabinet underneath the bathroom sink. There were safe toys and equipment available for children. There is a working telephone in the home. The Licensee did not furnish an EMSA approved pediatric CPR/First Aid certification and AB 1207 Mandated Reporter Training certificate. Licensee did not furnish evidence of immunization against Measles, Pertussis, and Influenza. (Continue to LIC 809-C)

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: BOSSON, VALERI J. FCCH	FACILITY NUMBER: 480110456
	VISIT DATE: 08/15/2023

NARRATIVE

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Cleaning compounds and sharps items in the kitchen were inaccessible. There is a functional smoke and carbon monoxide detectors; and a fully charged fire extinguisher rated at least 2A10BC. The Licensee stated she did not store any firearm(s) or other dangerous weapon(s) on site; and none were observed by LPA. LPA did not observe any poison(s).

There is an above ground swimming pool with an attached ladder in the backyard, and the pool did not meet fencing requirements. It is noted that there is an audible egress device installed on the sliding glass door which leads to the pool yard. There is an accessible container of gasoline and lawn mower in backyard. The Licensee stated at this time, she did not plan to care for children under 24 months old, and LPA did not see any play yards.

LPA discussed the safe sleep regulations with licensee 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 licensee 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.

During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. On this date, 08/15/2023, 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. (Continue to LIC 809-C)

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: BOSSON, VALERI J. FCCH	FACILITY NUMBER: 480110456
	VISIT DATE: 08/15/2023

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, 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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

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

Exit interview conducted and report was reviewed with the Licensee, Valeri Bosson. The following items are required to be corrected before the facility status may be changed, and a follow up inspection is required.

Ensure on-limit two bedroom, laundry and garage are made off-limits.
Place safety plastic covers on electrical wall outlets in living room & on-limit bedroom.
Clean living room carpet.
Cleaning compounds in cabinet underneath bathroom sink must be made inaccessible.
Furnish Licensee's current EMSA approved Pediatric CPR/First Aid certification.
Furnish Licensee's current AB 1207 Mandated Reporter Training certificate (mandatedreporterca.com).
Furnish Licensee's evidence of Measles, Pertussis and Influenza.
Ensure swimming pool in the backyard meets fencing requirements.
Submit proof showing required postings are posted.
Evidence showing container of gasoline and lawn mower were made inaccessible.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

LIC809 (FAS) - (06/04)

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