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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 115407729
Report Date: 07/01/2021
Date Signed: 07/01/2021 03:40:39 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:VAZQUEZ, OFELIA FAMILY CHILD CARE HOMEFACILITY NUMBER:
115407729
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
07/01/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Ofelia VazquezTIME COMPLETED:
03:45 PM
NARRATIVE
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On 7/1/2021 at 1:50pm, Licensing Program Analyst (LPA) Laura Chavez conducted an Annual Random inspection. The facility file was reviewed prior to this visit. A review of the Facility Personnel Report Summary dated 7/1/2021 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances. Currently three adults reside in the home. The home and grounds were toured, and the licensee was operating within the licensed capacity. No children were observed in parked cars. The licensee's days and hours of operation are Monday-Saturday, 5am-5pm. There is a working telephone in the home. The floor & yard plan were verified. The home is clean and orderly, with ventilation for safety and comfort. LPA observed toys, play equipment and materials available for children to be safe. The fire extinguisher, smoke detector and carbon monoxide detector in the home meet the standards required. Detergents, cleaning compounds, medications, and other items which could pose a danger to children are stored and inaccessible to children. Poisons are inaccessible to children and locked in a locked in the detached garage. The licensee stated there are no firearms and/or other dangerous weapons in the home, and none were observed during today's inspection. A review of children's records found that emergency contact information is missing for Children #5, #6, and #9. Immunization records are missing Children #1 thru #9. The licensee understands that any child showing signs of illness shall be separated from other children.

Report Continued: See LIC809-C
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura ChavezTELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021
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 3
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: VAZQUEZ, OFELIA FAMILY CHILD CARE HOME
FACILITY NUMBER: 115407729
VISIT DATE: 07/01/2021
NARRATIVE
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The licensee completed the Mandated Reporter Training on 6/20/202 as required. The licensee's CPR and First Aid expire 1/18/2022. The licensee's immunization's are on file as required. The children use the fenced in backyard as the outdoor play area. There were no pools or other bodies of water observed in or around the property. This report was reviewed and discussed with the Licensee. All licensing reports are public information and must be made available upon request for at least three years.
Notice of Site Visit shall be posted for 30 days from today's visit.

The following violations of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Appeal Rights were provided.
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura ChavezTELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: VAZQUEZ, OFELIA FAMILY CHILD CARE HOME
FACILITY NUMBER: 115407729
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/01/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/01/2021
Section Cited

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Immunization's: Prior to admission to a family day care home, parents/guardians of children shall provide of immunization's as required.

Immunization records not available for Child #1 thru Child #9
Type B
07/01/2021
Section Cited

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The licensee shall maintain, in each child's record, a copy of the emergency information card as required in Section 102417(g)(7).

Emergency information missing for Child #5, #6 and #9.

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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: Laura ChavezTELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 07/01/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/01/2021
LIC809 (FAS) - (06/04)
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