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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 125407570
Report Date: 12/18/2020
Date Signed: 12/18/2020 05:19:41 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:PEREZ, JENSHEN FAMILY CHILD CARE HOMEFACILITY NUMBER:
125407570
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 10DATE:
12/18/2020
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
04:30 PM
MET WITH:Jenshen PerezTIME COMPLETED:
05:30 PM
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A case management inspection was conducted via tele-inspection at the home by Licensing Program Analyst (LPA) Kiriko Lynch in response to an increase of capacity family child care home (FCCH) application received by the Department on 11/09/2020. The Licensee is requesting an increase in capacity from a small to a large license, and is currently operating as a large FCCH under the Department waiver due to the Covid-19 state of emergency. A fire clearance was obtained on 11/10/2020 from the local fire authority. There have been no other changes to the previous inside floor plan or outdoor yard plan. The same areas as before will be accessible to children in care with the addition of one additional restroom downstairs. During today's visit, the facility was toured and inspected. The facility was operating within the capacity and ratio requirements. No Title 22 deficiencies were observed. The capacity increase is granted as of today 12/18/2020.
SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Kiriko LynchTELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2020
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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