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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045405999
Report Date: 02/15/2023
Date Signed: 02/15/2023 03:04:00 PM


Document Has Been Signed on 02/15/2023 03:04 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
CHICO-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926



FACILITY NAME:DAVIS, ANGELA FAMILY CHILD CARE HOMEFACILITY NUMBER:
045405999
ADMINISTRATOR:DAVIS, ANGELAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 533-6934
CITY:OROVILLESTATE: CAZIP CODE:
95966
CAPACITY:14CENSUS: 14DATE:
02/15/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:55 PM
MET WITH:Angela DavisTIME COMPLETED:
03:10 PM
NARRATIVE
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Case Management Visit: On 2/15/23 at 2:55 PM Licensing Program Analyst (LPA) J. Helton conducted a Case Management unannounced visit to follow up on uncleared adult providing assistance on 12/5/22. The uncleared adult did not work until her background clearance cleared on 1/16/23, licensee stated she only worked a few hours on the 1 day.

A violation of The California Code of Regulations, Title 22; Division 12 was determined. Type A violation for uncleared adult, which poses an immediate health, safety, or personal rights risk to persons in care. Reports citing Type A violations are to be provided to parents/guardians of children currently enrolled and to parents/guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must sign Form LIC9224 and is to be kept in each child’s file.

See LIC809D

A copy of the report, appeal rights and a notice of site visit were given.

Exit interview was conducted with Licensee Angela Davis.

Notice of site visit must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 966-0216
LICENSING EVALUATOR NAME: Jackie HeltonTELEPHONE: 530-513-0993
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2023
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 2


Document Has Been Signed on 02/15/2023 03:04 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926


FACILITY NAME: DAVIS, ANGELA FAMILY CHILD CARE HOME
FACILITY NUMBER: 045405999

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/15/2023
Section Cited

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102370 Criminal Records Clearance (d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility: (1 )Obtain a California clearance or a criminal record exemption as required by the Department.
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 Licensee stated the uncleared adult only worked a couple hours on 12/5/22 and was no longer working at the FCCH until her background clearance was approved on 1/16/23.
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This requirement is not met as evidence by: Based on observation and interview, the licensee was operating with an uncleared adult in the facility, which poses an immediate health, safety, or personal rights risk to persons in care.
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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: Erin VirruetaTELEPHONE: (530) 966-0216
LICENSING EVALUATOR NAME: Jackie HeltonTELEPHONE: 530-513-0993
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2023
LIC809 (FAS) - (06/04)
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