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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010038
Report Date: 06/08/2023
Date Signed: 06/08/2023 04:25:56 PM

Document Has Been Signed on 06/08/2023 04:25 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:EL, SHELDON FCCHFACILITY NUMBER:
493010038
ADMINISTRATOR:EL, SHELDONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 708-8676
CITY:SANTA ROSASTATE: CAZIP CODE:
95404
CAPACITY: 14TOTAL ENROLLED CHILDREN: 9CENSUS: 6DATE:
06/08/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Yvonne PenaTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA), Amy Strother conducted a Plan of Correction (POC) visit and met with assistant, Yvonne Pena (S1) for the purpose of following up on six Type B deficiencies that were cited on 05/09/23. L1 was cited on 05/09/23 for the following; garage that contained lawn food and liquid starch was accessible to children, L1 was absent from the home in exceedance of 20 present of the hours that the facility is providing care per day, one staff person, S2 did not have a current mandated reporter certificate, L1 did not have a current liability insurance policy on file, and 3 out 5 children’s files (C2-C5) reviewed did not contain form LIC282, form LIC9227 was not in C5’s file as required, and form LIC9224 was not in 2 out of 5 children’s files (C1 & C5) as required. The purpose of today’s POC visit is to clear the above citations, all with a due date of 05/30/23.

On 5/14/23 S1 emailed LPA Strother a photo of a door with a locked dead bolt. LPA was unclear as to whether are not this lock made the garage inaccessible. Garage door was inspected during today's visit. S1 stated that the dead bold was replaced because a key could not be located for the old lock. The new lock was installed with the moveable latch on the homes inside and the key lock on the garage side. This did not meet the requirements of making the garage inaccessible, because children could unlock the door and enter the garage. LPA observed liquid starch and other bottles that appeared to be cleaners on the garage shelf.

Upon arrival, assistant S2 answered the door. S2 stated that 6 children were present, one infant and 5 preschool age children and that assistant Yvonne Pena (S1) was due to come back from her break in just a minute. LPA met with S1 who stated that Licensee Sheldon El has been present during days and hours of operation on one day, 06/01/23 since LPA's visit on 05/09/23.

LPA asked S2 if she had completed the mandated reporter training. S2 stated that although she had not provided a copy of the updated certificate to L1, she had completed the training. S2 logged into the mandated reporter training website and showed proof of a current training certificate, which expires 6/2025. S2 emailed a copy of the certificate to LPA Strother and stated that she emailed a copy to L1 and S1, clearing the citation.

Continue on LIC809-C

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE: DATE: 06/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/08/2023
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: EL, SHELDON FCCH
FACILITY NUMBER: 493010038
VISIT DATE: 06/08/2023
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During today’s inspection LPA reviewed files for C1-C5. Files for C2-C5 did not contain a signed form LIC282 and L1 did not have a current liability insurance policy on file for review. C5's file did contain a signed form LIC9227, clearing the citation. C1 and C5's files did not contain form LIC9224. Based on interview with S1, observation of garage door and file review of files for C1-C5, L1 did not meet the Plan of Correction for 4 out of the 6 Type B citations. LPA Strother issued a letter of deficiency citations cleared for 2 out of 6 of the citations from 05/09/23.

In accordance with California Code of Regulations (CCR), 101195(f), the Department is assessing a Civil Penalty for each of the four Type B violations not corrected, in the amount of $200 per citation, for a total of $800. See LIC421FC forms.

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

Exit interview conducted and report reviewed with S1. 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. Appeal Rights were provided.

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2023
LIC809 (FAS) - (06/04)
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