085407987-10-14-2021-13-CC-KLYH-C7SSTW-20211014141014

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 085407987
Report Date: 10/14/2021
Date Signed: 10/14/2021 02:10:21 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:	AGUIRRE-ANDERSON, SUZANNE FAMILY CHILD CARE HOME		FACILITY NUMBER:	085407987
ADMINISTRATOR:	AGUIRRE-ANDERSON, SUZANNE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(707) 954-0885
CITY:	CRESCENT CITY	STATE: CA	ZIP CODE:	95531
CAPACITY:	14	CENSUS: 0	DATE:	10/14/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Suzanne Aguirre-Anderson		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	A change of location/prelicensing was conducted today by Licensing Program Analyst (LPA) Kiriko Lynch. The applicant is requesting a license for a large family child care home with a capacity to serve up to fourteen children. Services will be provided Monday - Friday, 7:30 AM to 5:30 PM, and by appointment. The applicant understands that child care must be provided in the primary residence of the applicant. The residence is a 3 bedroom/2 bath home. Applicant stated she understands all adults residing or working at the home in care of children must have a criminal background clearance on file with Licensing. Fire clearance was approved on 10/12/21, and received by Licensing. Off-limits areas include: master bed/bath, second bedroom, laundry room, garage, and are made inaccessible by gates, fencing, and/or child safety knobs/latches/locked doors. The home appears to be clean and orderly. There is a working telephone. The sharp knives, cleaning supplies, medicines, are stored in inaccessible areas out of the reach of children. The children in care will have access to age appropriate toys and equipment. The home is equipped with a working smoke detector, carbon monoxide detector, and fire extinguisher per regulatory requirements. Home has wall unit for heating/cooling. Applicant stated there are no weapons in the home, and LPA did not observe any during today's visit. Backyard is fenced, and there are no bodies of water at the property. Applicant stated she understands that children require 100 percent supervision in all unfenced outdoor areas. Applicant stated she understands the requirement to contact Licensing if any major construction is done. Applicant stated she will utilize affidavit form until obtaining liability insurance. Proof of control of the property is on file. Applicant stated she understands emergency drills must be conducted at least once every six months, and the date documented. Report continues on next page

SUPERVISOR'S NAME: Erin Virrueta	TELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Kiriko Lynch	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021

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: AGUIRRE-ANDERSON, SUZANNE FAMILY CHILD CARE HOME	FACILITY NUMBER: 085407987
	VISIT DATE: 10/14/2021

NARRATIVE

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Children's records to be maintained at the facility were reviewed with applicant. Applicant stated she understands the facility roster is to remain current at all times. Unusual Incident Report procedures were explained to include notification before close of next business day, and follow up with written report within seven days to Licensing. The applicant stated she will remain current on Pediatric CPR/First Aid certification, and it expires on 05/28/22, and also Mandated Reporter Training certification and it expires on 06/02/22. The applicant stated she understands the capacity and ratio, and care and supervision requirements for the large family child care home. The applicant shall be present in the home per regulatory requirements, and shall ensure that children in care are supervised by an adult cleared through Licensing per background clearance regulatory requirements, with current Pediatric CPR and First Aid certification, and other requirements as necessary per regulatory requirements. The applicant stated she understands that children in care may only be transported by adults with a criminal record clearance and are never to be left unattended in a vehicle. The applicant stated she understands the responsibility to have knowledge and understand the laws and regulations for the operation of a family child care home. Forms and regulations, and child care updates and provider information notices (PINs), may be obtained from the website: www.ccld.ca.gov. The Megan's Law web site was provided: www.meganslaw.ca.gov. The applicant stated she understands that any authorized employee of the Department may enter and inspect the facility with or without advance notice. Incidental Medical Services (IMS) policy was discussed. For IMS 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 shall be submitted to the Department. The following information regarding 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. This report, as well as the new Safe Sleep Regulations, was reviewed and discussed with the applicant. 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.

Facility is licensed as of today, 10/14/21.

SUPERVISOR'S NAME: Erin Virrueta	TELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Kiriko Lynch	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021

LIC809 (FAS) - (06/04)

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