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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483009424
Report Date: 02/01/2024
Date Signed: 02/01/2024 01:58:38 PM

Document Has Been Signed on 02/01/2024 01:58 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:GRAY-MCDANIELS, CARLA FCCHFACILITY NUMBER:
483009424
ADMINISTRATOR:CARLA GRAY-MCDANIELSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 425-4057
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 7DATE:
02/01/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Licensee Carla Gray- McdanielsTIME COMPLETED:
02:10 PM
NARRATIVE
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During the course of a complaint investigation, Licensing Program Analysts ( LPAs) Melchisdeck Augustin and Elpidia Hernandez Torres made an unannounced Case Management (CM) visit to deliver a citation due to a deficiency that was observed. Upon arrival, LPA counted seven children including two infants present. During a tour of the facility interior, LPA, Hernandez Torres observed accessible container of Clorox wipes on the bathroom counter top and accessible cleaning compounds in the cabinet underneath the on limits kitchen sink. The compounds included gallon bleach, dish detergent, surface cleaner, carpet cleaner and arm and hammer baking soda. It was also noted there were multiple children in or in close proximity to the kitchen.

Exit interview conducted and report was reviewed with the Licensee, Carla Gray-McDaniels. 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(s) of the California Code of Regulations, Title 22; Division 12, were observed during today’s visit. See LIC 809-D. Appeal Rights were provided.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE: DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/01/2024
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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Document Has Been Signed on 02/01/2024 01:58 PM - It Cannot Be Edited


Created By: Elpidia Hernandez Torres On 02/01/2024 at 01:26 PM
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: GRAY-MCDANIELS, CARLA FCCH
FACILITY NUMBER: 483009424

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/02/2024
Section Cited
CCR
102417(g)(4)

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Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. This requirement is not met as evidence by. . .
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Licensee stated she was about to clean when LPAs arrived that's why they were out. Licensee reported she will wait until the children are in the living room before bringing the cleaning items out. Licensee reported it won't happen again.
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. . . based on LPAs observations of accessible cleaning compounds in the on limit areas; the bathroom counter and in the kitchen underneath the sink. This poses a potential health and safety risk to children in care.
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Licensee agreed to write a statement to LPA Hernandez Torres on or before

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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:Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE:
DATE: 02/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/01/2024


LIC809 (FAS) - (06/04)
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