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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 065407577
Report Date: 07/07/2021
Date Signed: 07/07/2021 04:23:49 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 HOMEFACILITY NUMBER:
065407577
ADMINISTRATOR:JIMENEZ, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 844-8863
CITY:COLUSASTATE: CAZIP CODE:
95932
CAPACITY:14CENSUS: 5DATE:
07/07/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Maria JimenezTIME COMPLETED:
02:20 PM
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On 7/7/2021 at 1:15pm, Licensing Program Analyst (LPA) Laura Chavez conducted an Annual Random inspection. The facility file was reviewed prior to this visit. A review of the Facility Personnel Report Summary dated 7/1/2021 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances. Currently three adults reside in the home. The home and grounds were toured, and the licensee was operating within the licensed capacity. No children were observed in parked cars. The licensee's days and hours of operation are Monday-Friday, 7am-5pm. There is a working telephone in the home. The floor & yard plan were verified. The home is clean and orderly, with ventilation for safety and comfort. LPA observed toys, play equipment and materials available for children to be safe. The fire extinguisher, smoke detector and carbon monoxide detector in the home meet the standards required. Detergents, cleaning compounds, medications, and other items which could pose a danger to children are stored and inaccessible to children. Poisons are inaccessible to children and locked in the detached garage. The licensee stated there are no firearms and/or other dangerous weapons in the home, and none were observed during today's inspection. A review of nine children's records found copies of emergency contact information as required. The licensee understands that any child showing signs of illness shall be separated from other children. The licensee has not renewed the Mandated Reporter Training as required. The licensee's CPR and First Aid expire 6/12/2023. The licensee's immunization's are on file.
Report Continued: See LIC809-C
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura ChavezTELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021
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: JIMENEZ, MARIA FAMILY CHILD CARE HOME
FACILITY NUMBER: 065407577
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/07/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/07/2021
Section Cited

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A licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal of the mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
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This requirement was not met as evidenced by: The licensee stating that she has not renewed the mandated reporter training as required.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura ChavezTELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 07/07/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/07/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: 07/07/2021
NARRATIVE
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The children use the front and back yard as their outdoor play area. The licensee agrees to provide constant supervision when children are in the partially fenced in front yard. There were no pools or other bodies of water observed in or around the property. 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.

The following violation of the California Code of Regulations, Title 22; Division 12, were observed: see LIC809-D. Appeal Rights were provided.
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura ChavezTELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021
LIC809 (FAS) - (06/04)
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