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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 115407759
Report Date: 07/09/2021
Date Signed: 07/09/2021 12:34:06 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:DOMINGUEZ-GARCIA, CONSUELO FAMILY CHILD CARE HOMEFACILITY NUMBER:
115407759
ADMINISTRATOR:DOMINGUEZ-GARCIA, CONSUELOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 519-6211
CITY:ORLANDSTATE: CAZIP CODE:
95963
CAPACITY:14CENSUS: 14DATE:
07/09/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Consuelo Dominguez-GarciaTIME COMPLETED:
12:40 PM
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On 7/9/21 at 11:50am, an annual inspection was made to the facility by Licensing Program Analyst (LPA), Grisak. A review of staff records on 7/9/21 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. There are currently two adults living in the home.
At 11:55am the home was toured inside and outside. The licensee and assistant were supervising 14 children, and operating within the licensed capacity and ratio requirements. The facility’s operating hours are 7am to 5pm, Monday–Friday. The floor plan submitted by the licensee was reviewed and verified. The off-limits areas of the home are one bedroom located near the front entrance of the home, and were made inaccessible by door knob covers. Poisons are locked in outdoor shed. Items which could pose a danger to children (detergents, cleaning compounds, medications, etc.) are stored out of the reach of children. There is a working smoke detector, carbon monoxide detector and fire extinguisher, rated at least 2A10BC, in the home. The licensee stated there are no firearms and/or other dangerous weapons in the home, and none were observed during today's inspection. The home is clean, orderly and comfortable. There are safe toys and equipment available for children. There is a working telephone in the home.
There is a crib available for napping infants if needed, however there are not currently any infants under 12 months attending. Cribs have firm mattresses and are free of loose objects. Bedding is laundered weekly, and soiled bedding is stored inaccessible to infants. Napping infants are checked on every 15 minutes, and checks will be documented. No infants were observed to be swaddled.
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. 14 children's records were reviewed at 12:10pm; required emergency information forms were observed to be on file. The licensee has completed Mandated Reporter training. The licensee and all employees have the required immunizations on file. The licensee has current pediatric CPR and First Aid certification, which expire on 5/22/23.
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. There were no Title 22 deficiencies cited during today's inspection.
Notice of Site Visit shall be posted for 30 days from today's visit.
SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Emilia GrisakTELEPHONE: (530) 895-5821
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2021
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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