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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 115406755
Report Date: 11/12/2021
Date Signed: 11/12/2021 11:07:08 AM

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:GONZALEZ, ERIKA FAMILY CHILD CARE HOMEFACILITY NUMBER:
115406755
ADMINISTRATOR:GONZALEZ, ERIKAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 586-9199
CITY:ORLANDSTATE: CAZIP CODE:
95963
CAPACITY:14CENSUS: 4DATE:
11/12/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Erika GonzalezTIME COMPLETED:
10:25 AM
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A case management Licensee initiated inspection was conducted by Licensing Program Analyst (LPA) Mendez in response to a new floor plan submitted by licensee. Licensee had garage converted into daycare room and will be used for the children, the house will not be accessible to children and families. Daycare room entrance is on the side of the house accessible by a side gate. Daycare room has bathroom accessible to children and a kitchenette is in the daycare room and stove has knob covers. The floor plan was submitted by licensee and verified. A fire clearance for the room was granted on 11/3/21. Electrical outlets were covered. The fire extinguisher is rated at least 2A-10 BC and located under the kitchen sink. Cleaning supplies are kept on a high shelf on cabinet not accessible to children. There is a working smoke detector and carbon monoxide detector in the daycare room. Clearance is granted for licensee to use daycare room for children.
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Bianca MendezTELEPHONE: (530) 895-4357
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021
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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