065406451-5-11-2023-13-CC-LCHZ-CRQSAC-20230511134207

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 065406451
Report Date: 05/10/2023
Date Signed: 05/11/2023 01:42:14 PM

Document Has Been Signed on 05/11/2023 01:42 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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME:	CERVANTES, LAURA FAMILY CHILD CARE HOME		FACILITY NUMBER:	065406451
ADMINISTRATOR:	CERVANTES, LAURA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(530) 632-7936
CITY:	COLUSA	STATE: CA	ZIP CODE:	95932
CAPACITY:	14	CENSUS: 10	DATE:	05/10/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Laura Cervantes		TIME COMPLETED:	12:25 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	On 5/10/2023 at 10:00AM, a Required 1-Year inspection was made to the facility by Licensing Program Analyst (LPA), Laura Chavez. At 10:25am the home was toured inside and outside. The licensee and her assistant were supervising 10 children, and operating within the licensed capacity and ratio requirements. The facility’s operating hours are 7:00am - 5:00pm, Monday–Friday. The floor plan submitted by the licensee was reviewed and verified. The main part of the home is off-limits to children and made inaccessible by a lock on the door leading into the home from the day-care room. The children use the back yard as the outdoor play area and it is fully fenced. There is an in-ground pool in the back yard. The pool is fully fenced with a mesh pool fence. Five children's records were reviewed at 11:35am. Two staff records were reviewed at 11:00am. There are currently two adults living in the home. The licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura Chavez	TELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

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: CERVANTES, LAURA FAMILY CHILD CARE HOME	FACILITY NUMBER: 065406451
	VISIT DATE: 05/10/2023

NARRATIVE

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LPA discussed the safe sleep regulations with licensee Laura Cervantes and discussed the Child Care Licensing Safe Sleep web page at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-
resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. The following information regarding ADA was provided: US Department of Justice (USDOJ) 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, available at: http://www.ada.gov/childqanda.htm

There were no deficiencies cited during today’s inspection. An exit interview conducted and report was reviewed with the licensee Laura Cervantes.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at:www.cdss.ca.gov/inforesources/community-care-licensing/process.

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.

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura Chavez	TELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

LIC809 (FAS) - (06/04)

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