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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 255407922
Report Date: 09/10/2021
Date Signed: 09/13/2021 10:05:32 AM

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:NEWELL, DAWN FAMILY CHILD CARE HOMEFACILITY NUMBER:
255407922
ADMINISTRATOR:NEWELL, DAWNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 365-9448
CITY:ALTURASSTATE: CAZIP CODE:
96101
CAPACITY:14CENSUS: 0DATE:
09/10/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Dawn NewellTIME COMPLETED:
01:00 PM
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A change of location inspection was conducted today by LPA Mendez. This inspection was conducted in person on 9/10/21. The licensee is requesting a license for a capacity of 14.. Services will be provided Mon-Fri 6:30am-7:00pm The residence is a two bedroom/ one bathroom home. There is one adult living in the home. The applicant was advised that all adults residing or working at the facility must have a criminal background clearance on file with CCLD. The applicant is aware of the immediate $100 per day civil penalty for adults working or residing in the home without a criminal record clearance.

Children will have access to the living room, bathroom and kitchen. Bedrooms and office/living room area is inaccessible to children. Household cleaners are stored a locked cabinet in the garage. The sharp knives and medications are stored out of the reach of children. Sharp knives are on a high cabinet shelf. There are no firearms stored in the home. The children in care will have access to age appropriate toys and equipment. The home is equipped with a working smoke detector and carbon monoxide detector. A fire extinguisher rated at least 2A10BC was observed. The children will use the backyard as the outdoor play area and it is fully fenced. No bodies of water was observed. Licensee is up to date on CPR/First Aid expires 7/2023, PHP completed on .

The applicant may intend to provide Incidental Medical Services – IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. A Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm. Infant safe sleep regulations was discussed and information was provided.

Parents will be required to sign insurance affidavits if the provider does not plan to purchase additional child care liability insurance. Parent's rights poster is posted. Emergency drills must be conducted at least once every six months and the date documented. Children's records to be maintained were reviewed. The roster is to remain current at all times. Unusual Incident Report procedures were explained, to include notification before close of next business day and follow-up with written report within seven days.

SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Bianca MendezTELEPHONE: (530) 895-4357
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2021
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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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: NEWELL, DAWN FAMILY CHILD CARE HOME
FACILITY NUMBER: 255407922
VISIT DATE: 09/10/2021
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Any proposed changes to the physical plant, telephone number, or change of address shall be immediately reported to the Department.
The following items need to be sent to the office before being licensed
1. Rooms that are off limits need to have door knob covers/ or bolts
SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Bianca MendezTELEPHONE: (530) 895-4357
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2021
LIC809 (FAS) - (06/04)
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