065407577-8-2-2019-13-CC-LCHZ-BENVMU-20190802163407

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 065407577
Report Date: 07/24/2019
Date Signed: 08/02/2019 04:34:11 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:	JIMENEZ, MARIA FAMILY CHILD CARE HOME		FACILITY NUMBER:	065407577
ADMINISTRATOR:	JIMENEZ, MARIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(530) 844-8863
CITY:	COLUSA	STATE: CA	ZIP CODE:	95932
CAPACITY:	14	CENSUS: 0	DATE:	07/24/2019
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	12:05 PM
MET WITH:	Maria Jimenez		TIME COMPLETED:	01:10 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	LPA Laura Chavez conducted a prelicensing visit in response to an application for a change of location. The requested capacity is 14. An approved fire safety inspection was received on 7/24/2019. The home is a 3 bedroom 2 bathroom home. The home was toured inside and outside. The floor and yard plan were verified. The master bedroom and laundry area are off-limits to children. The master bedroom has been made off-limits by means of a doorknob cover and a gate prevents children from accessing the laundry area. Days and hours of operation are Monday through Friday; 7:00am - 5:00pm. The licensee understands that 24 hour care to one child at one time is not allowed. Two adults reside in the home. The home is clean and orderly at this time and should remain so during child care hours. Electrical outlets were covered and cords to window blinds were not accessible. The licensee is not the property owner. The Property Owner/Landlord Consent and Property Owner/Landlord Notification are on file. There are age appropriate toys available for the children. There is a working smoke detector, carbon monoxide detector and a fully charged fire extinguisher in the home. The sharp knives, cleaning supplies, medicines, are stored out of the reach of children. Poisons are locked in a storage shed located off the property. The licensee understands that poisons shall be locked should any are brought into the home. The licensee understands that emergency disaster drills shall be conducted and documented at least once every six months. The licensee stated there are no firearms and or other dangerous weapons in the home and none were observed during today's visit. The children will use the side yard as the outdoor play area and it is not fully fenced. The licensee understands that constant visual supervision shall be provided until the outdoor play area is completely fenced in. There is no pool, spa, or ponds, nor any other source of water accessible to the children, and none of these items are to be added without prior notification and approval of the licensing agency. The licensee's pediatric CPR and First Aid expire 8/24/2019. The licensee was reminded of 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 licensee is aware of the immediate $100 per day civil penalty for adults working or residing in the home without a criminal record clearance. Incidental Medical Services (IMS) policy was discussed. For IMS 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: 07/24/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2019

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: JIMENEZ, MARIA FAMILY CHILD CARE HOME	FACILITY NUMBER: 065407577
	VISIT DATE: 07/24/2019

NARRATIVE

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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 the American Disabilities Act (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.

All licensing reports are public information and must be made available upon request for at least three years.

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

The home is ready for licensure.

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura Chavez	TELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2019

LIC809 (FAS) - (06/04)

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