045407357-8-19-2021-13-CC-EGRK-C62P84-20210819110457

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 045407357
Report Date: 08/19/2021
Date Signed: 08/19/2021 11:05:03 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME:	GROSS, IVORY FAMILY CHILD CARE HOME		FACILITY NUMBER:	045407357
ADMINISTRATOR:	GROSS, IVORY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(530) 712-1492
CITY:	OROVILLE	STATE: CA	ZIP CODE:	95965
CAPACITY:	14	CENSUS: 6	DATE:	08/19/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Ivory Gross		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	On 8/19/21 at 10:10am, an annual required inspection was made to the facility by Licensing Program Analyst (LPA), Emilia Grisak. A review of staff records on 8/19/21 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. There are currently two adults living in the home. At 10:20am the home was toured inside and outside. The licensee and an assistant were supervising 6 children, and operating within the licensed capacity and ratio requirements. The facility’s normal operating hours are 7:30am - 4:30pm, Monday–Friday. The floor plan submitted by the licensee was reviewed and verified. The off-limits areas of the home are the entire home except for the daycare room and a bathroom. The rest of the home was made inaccessible by baby gates/door locks. There are no poisons present but licensee was advised that poisons must be locked. Items which could pose a danger to children (detergents, cleaning compounds, medications, etc.) are stored out of the reach of children. There is a working smoke detector, carbon monoxide detector and fire extinguisher, rated at least 2A10BC, in the home. The licensee stated there are no firearms and/or other dangerous weapons in the home, and none were observed during today's inspection. The home is clean, orderly and comfortable. There are safe toys and equipment available for children. There is a working telephone in the home. There are cribs/play yards available for napping infants. Cribs/play yards have firm mattresses and are free of loose objects. Bedding is laundered weekly, and soiled bedding is stored inaccessible to infants and washed immediately. Napping infants are checked on every 15 minutes, and checks will be documented. No infants were observed to be swaddled, and infants under 12 months are placed on their backs for sleeping.

SUPERVISOR'S NAME: Erin Virrueta	TELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Emilia Grisak	TELEPHONE: (530) 895-5821
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021

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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: GROSS, IVORY FAMILY CHILD CARE HOME	FACILITY NUMBER: 045407357
	VISIT DATE: 08/19/2021

NARRATIVE

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The children use the back yard as the outdoor play area and it is fully fenced. Children are not currently going outside due to poor air quality but the backyard was toured. Furniture and equipment are in good condition and free of hazards. There were no pools or other bodies of water observed in the yard.

Five children's records were reviewed at 10:45am; required emergency information forms were observed to be on file. The licensee has completed Mandated Reporter training. The licensee and all employees have the required immunizations on file. The licensee has current pediatric CPR and First Aid certification, which expire on 8/2022.

This report was reviewed and discussed with the licensee. All licensing reports are public information and must be made available upon request for at least three years.

Notice of Site Visit shall be posted for 30 days from today's visit.

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

SUPERVISOR'S NAME: Erin Virrueta	TELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Emilia Grisak	TELEPHONE: (530) 895-5821
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021

LIC809 (FAS) - (06/04)

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