<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045407621
Report Date: 01/29/2020
Date Signed: 01/29/2020 11:58:45 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:BOLANOS GUTIERREZ, CRISTAL FAMILY CHILD CARE HOMEFACILITY NUMBER:
045407621
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 2DATE:
01/29/2020
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Cristal Bolanos GutierrezTIME COMPLETED:
12:15 PM
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 pre-licensing visit was conducted today by Licensing Program Analyst (LPA) David Wilson at this home located at 1775 Hammon Avenue, Oroville Ca 95966 (the above address typo data will be corrected before any licensing). The applicant has requested a license for a capacity of eight. Services will normally be provided Monday thru Friday; 7:00am - 5:30pm. The residence is a three bedroom/one bath home. Applicant was advised that all adults residing or working at the facility must have a criminal background clearance on file with CCLD. All minors residing in the home must be fingerprinted within 30 days of reaching their 18th birthday and obtain a TB clearance. The applicant is aware of an immediate $100 per day civil penalty for adults working or residing in the home without a criminal record clearance.

The upstairs three bedrooms and attached garage are off limits to the children. The bedrooms have been made inaccessible by means of doorknob covers and garage inaccessible by means of garage door lock. The home appeared to be clean and orderly at this time and will remain so during child care hours. There was a working telephone in the home. The sharp knives, cleaning supplies, and medicines were stored out of the reach of children. The applicant stated poisons were locked in garage; none were observed accessible. The applicant reported there are no weapons and no ammunition in the home; none were observed during the visit. The children in care will have access to age appropriate toys and equipment. The home was equipped with a working smoke detector and carbon monoxide detector. Applicant stated electrical fireplace is not used. LPA advised if to use fireplace that a screen must be in place to prevent children's contact with hot areas. Currently it is planned the children will use the backyard deck that is attached directly adjacent to the home as the outdoor play area. The remaining portion of the completely fenced backyard per applicant is currently off limits. There was a trampoline in he off limits portion of backyard and applicant stated will not use during day care hours. LPA advised if to use trampoline during day care hours that must follow manufactures instructions and only one child at a time allowed to be on trampoline. There was no pool, spa, pond, fountain, nor any other source of water accessible to the children, and none is to be added without prior notification and approval of the licensing agency. Continued on next page...
SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: David WilsonTELEPHONE: (530) 513-0993
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2020
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
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: BOLANOS GUTIERREZ, CRISTAL FAMILY CHILD CARE HOME
FACILITY NUMBER: 045407621
VISIT DATE: 01/29/2020
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
26
27
28
29
30
31
32
Parents will be required to sign insurance affidavits if the provider does not plan to purchase additional child care liability insurance. Proof of control of property or landlord notification/consent is on file. Parents' rights were posted. Emergency drills must be conducted at least once every six months and the date must be documented. The roster is to remain current at all times. Unusual Incident Report procedures were explained, to include notification before close of next business day and follow-up with written report within seven days. The applicant will maintain current Pediatric CPR and First Aid. The applicant shall be present in the home and shall ensure that children in care are supervised by a fingerprinted adult with current Pediatric CPR and First Aid certification. The applicant understood that children may only be transported by adults with a criminal record clearance and are never to be left unattended in a vehicle. The applicant understood the maximum number of children for whom care can be provided and the limitations on the number of infants (birth to age 2) that may be cared for and when two of the children in care must be school-aged. Smoking is prohibited in the home at all times and in outdoor areas where children are present.

The applicant has currently no plans to treat for Incidental Medical Services (IMS); however the IMS policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 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,www.ada.gov/childqanda.htm.
The applicant understood the responsibility to read and have knowledge of the laws and regulations for operation of a family child care home. Forms and regulations must be obtained from the website (http://ccld.ca.gov/). Megan's Law web site was provided (http://www.meganslaw.ca.gov). The licensee understood that any authorized employee of the Department may enter and inspect the facility with or without advance notice. This report, as well as the American Academy of Pediatrics Safe Sleep Guide was reviewed and discussed with the applicant.
Any proposed changes to the physical plant, telephone number, or change of address shall be immediately reported to the Department.

The following item(s) need to be completed prior to the granting of license. Please include facility number in all correspondence.
1. Home is required to have a fire extinguisher rated at least 2A:10B:C.
SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: David WilsonTELEPHONE: (530) 513-0993
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2020
LIC809 (FAS) - (06/04)
Page: 2 of 2