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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 115407078
Report Date: 11/28/2022
Date Signed: 11/28/2022 01:27:02 PM


Document Has Been Signed on 11/28/2022 01:27 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
CHICO-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926



FACILITY NAME:GRIFFITH, JENNIFER FAMILY CHILD CARE HOMEFACILITY NUMBER:
115407078
ADMINISTRATOR:GRIFFITH, JENNIFERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 828-4218
CITY:ORLANDSTATE: CAZIP CODE:
95963
CAPACITY:14CENSUS: 9DATE:
11/28/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:06 PM
MET WITH:Jennifer Griffith, LicenseeTIME COMPLETED:
01:45 PM
NARRATIVE
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On 11/28/22 @ approximately 11:45am Licensing Program Analyst's (LPA's) Laura Chavez and Erica Laird conducted a case management inspection for the purpose of interviewing staff and children. Upon arrival to the facility, LPA's observed S1 caring for 9 children and operating out of ratio. Licensee arrived at approximately 12:11pm.

The following deficiency was cited (see LIC 809D):

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. Copy of appeal rights were given to licensee.
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Erica LairdTELEPHONE: 530-895-5045
LICENSING EVALUATOR SIGNATURE:
DATE: 11/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/28/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 11/28/2022 01:27 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926


FACILITY NAME: GRIFFITH, JENNIFER FAMILY CHILD CARE HOME
FACILITY NUMBER: 115407078

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/28/2022
Section Cited

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Staffing Ratio and Capacity: If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c)

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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: Erica LairdTELEPHONE: 530-895-5045
LICENSING EVALUATOR SIGNATURE:
DATE: 11/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/28/2022
LIC809 (FAS) - (06/04)
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