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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 115405323
Report Date: 06/03/2022
Date Signed: 06/03/2022 02:59:54 PM


Document Has Been Signed on 06/03/2022 02:59 PM - It Cannot Be Edited

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:EDEN, CAROLYN FAMILY CHILD CARE HOMEFACILITY NUMBER:
115405323
ADMINISTRATOR:EDEN, CAROLYNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 865-8388
CITY:ORLANDSTATE: CAZIP CODE:
95963
CAPACITY:14CENSUS: 9DATE:
06/03/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Carolyn EdenTIME COMPLETED:
03:10 PM
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On 6/3/22 at 1:35pm, an annual required inspection was made to the facility by Licensing Program Analyst (LPA), Emilia Grisak. At 2:30pm the home was toured inside and outside. When LPA arrived two assistants were supervising nine children and licensee arrived shortly after, and facility is operating within the licensed capacity and ratio requirements. The facility’s operating hours are 7am to 5:30pm, Monday–Friday. The floor plan submitted by the licensee was reviewed and verified. The entire inside of the home except the utility room is accessible to children, the utility room is locked. The children use the back yard as the outdoor play area and it is fully fenced. There were no pools or other bodies of water observed in the yard.

Nine children's records were reviewed at 1:50pm. Three staff records were reviewed at 2:00pm.

There is currently one adult living in the home. The Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Emilia GrisakTELEPHONE: (530) 895-5821
LICENSING EVALUATOR SIGNATURE:
DATE: 06/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/03/2022
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: EDEN, CAROLYN FAMILY CHILD CARE HOME
FACILITY NUMBER: 115405323
VISIT DATE: 06/03/2022
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LPA was advised that no children are enrolled under the age of two and LPA advised licensee that if infants are ever enrolled to refer to Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.

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 must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) 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, available at: http://www.ada.gov/childqanda.htm

There were no deficiencies cited during today’s inspection



Exit interview conducted and report was reviewed with the licensee Carolyn Eden.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Emilia GrisakTELEPHONE: (530) 895-5821
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2022
LIC809 (FAS) - (06/04)
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