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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045407621
Report Date: 02/02/2021
Date Signed: 02/09/2021 12:12:12 PM

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:BOLANOS GUTIERREZ, CRISTALFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 433-8351
CITY:OROVILLESTATE: CAZIP CODE:
95966
CAPACITY:14CENSUS: 8DATE:
02/02/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Cristal Bolanos-GutierrezTIME COMPLETED:
02:30 PM
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The facility inspection was conducted via tele-inspection due to the current state of emergency regarding the COVID-19 outbreak by Licensing Program Analyst (LPA) Wisehart on 2/2/21 at 2 pm - 2:30 pm and continued the visit on 2/3/21 at 2 pm - 2:20 pm.

The licensee has requested a license capacity increase to 14 children. The fire authority approved the fire clearance on 1/26/21 for 14. Services will be available Monday thru Friday; 7:30am - 5:30pm. The residence is a three bedroom/one bath home. 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 the garage inaccessible by means of a garage door lock. The home appeared to be clean and orderly at time of visit 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 licensee stated poisons were locked in garage; none were observed accessible. The licensee reported there are no weapons and no ammunition in the home; none were observed during the visit. The children in care have access to age appropriate toys and equipment. The home was equipped with a working smoke detector and carbon monoxide detector. The licensee stated the electrical fireplace is not used. The License understood that if the fireplace is ever used, a secured fire screen must be in place. The outdoor play area is reached via steps quipped with hand rails and the play area is gated and fully fenced in. The licensee has a trampoline which is not use during day care hours. LPA advised if the trampoline is used during day care hours they must follow manufactures instructions and only one child at a time is allowed to be on the trampoline. There were no bodies of water ( 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: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Carrie WisehartTELEPHONE: (530) 895-5824
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2021
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: 02/02/2021
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 The licensee will maintain current Pediatric CPR and First Aid (expires 5/21). The Licensee will remain current on Mandated Reporter Training (expires 5/21/21). The Licensee took her Preventative Health Practices class 4/27/19 and the lead certificate on 11/30/20. The licensee 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-age.

Incidental Medical Services (IMS) policy was discussed. 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 licensee 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 licensee.

Any proposed changes to the physical plant, telephone number, or change of address shall be immediately reported to the Department.The Notice of Site Visit must be posted for 30 days.

No deficiencies were cited during today's tele visit.
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Carrie WisehartTELEPHONE: (530) 895-5824
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2021
LIC809 (FAS) - (06/04)
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