065407857-12-30-2020-13-CC-LCHZ-BWSSX6-20201230131526

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 065407857
Report Date: 12/29/2020
Date Signed: 12/30/2020 01:15:57 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:	CERVANTES, DIANA FAMILY CHILD CARE HOME		FACILITY NUMBER:	065407857
ADMINISTRATOR:	CERVANTES, DIANA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(530) 870-7719
CITY:	WILLIAMS	STATE: CA	ZIP CODE:	95987
CAPACITY:	14	CENSUS: 2	DATE:	12/29/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Diana Cervantes		TIME COMPLETED:	04:45 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 12/29/2020 at 3:30pm, Licensing Program Analyst (LPA) Laura Chavez conducted a pre-licensing inspection in response to an application for a capacity of 14. A Fire Inspection was approved on 12/17/2020. The prelicensing inspection was conducted via tele-inspection due to the current State of Emergency caused by COVID-19. A COVID-19 Self-Assessment Guide and posters provided were discussed and reviewed with the applicant. COVID-19 related posters shall be posted. Days and hours of operation are Monday-Friday; 7:00am-5:00pm. The applicant is the homeowner. The applicant understands that child care must be provided in the primary residence. The applicant understands that 24 hour care shall not be provided to one child at any one time. The applicants CPR and First Aid expire 11/11/2022. The home was toured via FaceTime inside and out. The residence is a three bedroom, three bath home. Two adults and two minors reside in the home. The floor and yard plans previously submitted were verified. The dining room, kitchen, garage, master bedroom, master bath, bedroom #2 and bathroom #2 as designated on the floor plan are off-limits to children. Gates have been installed to prevent children from accessing these areas. There are two fireplaces in the home. The fireplace located in the living-room is non-operable and only for ornamental purposes. A switch plate cover has been installed to prevent the second fireplace located in the dining room from being turned on. The applicant agrees to make the second fireplace inaccessible should it be used while children are in care. Electrical outlets were covered. No cords to window blinds were observed. There is a working telephone. The sharp knives, medicines, cleaning supplies are stored out of the reach of children. Poisons are locked in a cabinet located in the garage. There are age appropriate toys available for the children. There are working smoke detectors, carbon monoxide detectors and a fully charged fire extinguisher rated at least 2A:10:BC in the home. 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: 12/29/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2020

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, DIANA FAMILY CHILD CARE HOME	FACILITY NUMBER: 065407857
	VISIT DATE: 12/29/2020

NARRATIVE

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Notification of Parents Rights, Emergency Disaster Plan, with the Earthquake Preparedness Checklist shall be posted. The applicant is aware that all adults residing or working at the facility must have a criminal background clearance on file with CCLD. Minors residing in the home must be fingerprinted within 30 days of reaching their 18th birthday and obtain a TB clearance. The applicant is aware of the immediate $100 per day civil penalty for adults working or residing in the home without a criminal record clearance. The applicant understands that if she does not carry liability insurance for the family child care home, parents will be required to sign insurance affidavits. A sample of forms typically given during pre-licensing visits were provided and explained. The roster of children in care shall remain current at all times. Children's records are to be maintained and kept current at all times. The applicant was reminded of the responsibility of reporting unusual incidents to CCLD within 24 hours or the next business day. The following information regarding the American Disabilities Act (ADA) was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/childqanda.htm. The applicant will conduct and document emergency disaster drills at least once every six months. The applicant stated that there are no firearms and or other dangerous weapons in the home and none were observed during today's inspection. The children will use the backyard as the outdoor play area. The backyard is completely fenced. There is no pool, spa, pond, 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 applicant agrees to keep the My First Trampoline in the off-limits area of the backyard. The applicant clearly understands 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 one child in kindergarten or elementary school and one child at least age 6. Smoking is prohibited during the hours of operation. The applicant understands the responsibility of securing copies of forms and regulations from the website (www.ccld.ca.gov). Megan's Law is available at www.meganslaw.ca.gov/.

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

The home is ready to be licensed.

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura Chavez	TELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:	DATE: 12/29/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2020

LIC809 (FAS) - (06/04)

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