065407539-6-15-2021-13-CC-LCHZ-C3ZLQ4-20210615085653

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 065407539
Report Date: 06/14/2021
Date Signed: 06/15/2021 08:57:16 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:	CALLAHAN, JENNIFER FAMILY CHILD CARE HOME		FACILITY NUMBER:	065407539
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 6	DATE:	06/14/2021
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	Jennifer Callahan		TIME COMPLETED:	02:45 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 6/14/2021 at 1:40pm, Licensing Program Analyst (LPA) Laura Chavez conducted a case management inspection in response to an application received for an increase in capacity of 14. An approved fire inspection was received on 6/7/2021. Days and hours of operation are Monday-Friday;7:30am-5:30pm. Currently two adults reside in the home. A review of the Facility Personnel Report Summary dated 6/11/2021 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. During today’s inspection the home and grounds were toured. The floor and yard sketch submitted was reviewed. The residence is a three bedroom, two bath home. The master bedroom/bathroom, bedroom #2 and garage are off-limits and have been made inaccessible by locks and doorknob covers. The home is clean and orderly and will remain so during child care hours. There is a working telephone. The sharp knives, cleaning supplies, medicines, are stored out of the reach of children. Poisons are locked in the shed located on the side of the home. The weapons in the home are locked as required. The home is equipped with a working smoke detector, carbon monoxide detector and fire extinguisher rated at least 2A10BC. The children use half of the backyard as their outdoor play area. Report Continued: See LIC 809-C

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura Chavez	TELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:	DATE: 06/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2021

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: CALLAHAN, JENNIFER FAMILY CHILD CARE HOME	FACILITY NUMBER: 065407539
	VISIT DATE: 06/14/2021

NARRATIVE

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The backyard is divided by a wrought iron fence. The other half of the backyard has an enclosed duck pond. The fence which surrounds the duck pond meets pool fencing requirements. 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.

Any proposed changes to the physical plant, telephone number, or change of address shall be immediately reported to the Department.

The following is required prior to increasing the capacity:
1. Current CPR/First Aid.

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura Chavez	TELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:	DATE: 06/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2021

LIC809 (FAS) - (06/04)

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