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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 115407808
Report Date: 09/30/2021
Date Signed: 10/01/2021 01:55:36 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:CLOYD, MELISSA FAMILY CHILD CARE HOMEFACILITY NUMBER:
115407808
ADMINISTRATOR:CLOYD, MELISSAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 865-1054
CITY:ORLANDSTATE: CAZIP CODE:
95963
CAPACITY:14CENSUS: 5DATE:
09/30/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:37 PM
MET WITH:Melissa CloydTIME COMPLETED:
02:25 PM
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On 9/30/21 at 1:37pm, an annual required inspection was made to the facility by Licensing Program Analyst (LPA), Emilia Grisak. A review of staff records on 9/30/21 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 and two minors living in the home.
At 1:40pm the home was toured inside and outside. The licensee was supervising 5 children, and operating within the licensed capacity and ratio requirements. The facility’s operating hours are 7:30am - 5:30pm, Monday–Friday. The floor plan submitted by the licensee was reviewed and verified. The off-limits areas of the home are three bedrooms and a bathroom, and were made inaccessible by baby gates. There were no poisons present. 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. There are safe toys and equipment available for children. There is a working telephone in the home.
There are cribs/play yards available for napping infants. Cribs/play yards have firm mattresses and are free of loose objects. Bedding is laundered at least weekly, and soiled bedding is stored inaccessible to infants. Napping infants are checked on every 15 minutes, and checks are documented on a notebook. No infants were observed to be swaddled, and infants under 12 months are placed on their backs for sleeping.
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.
Three children's records were reviewed at 2:00pm; required emergency information forms were observed to be on file. The licensee has completed Mandated Reporter training. The licensee has required immunizations on file. The licensee has current pediatric CPR and First Aid certification, which expires on 10/3/22.
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: 09/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2021
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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