325408036-5-18-2022-13-CC-KMAS-CEJRT3-20220518131739

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 325408036
Report Date: 05/18/2022
Date Signed: 05/18/2022 01:17:59 PM

Document Has Been Signed on 05/18/2022 01:17 PM - It Cannot Be Edited

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:	TISSOT, KRISTIN FAMILY CHILD CARE HOME		FACILITY NUMBER:	325408036
ADMINISTRATOR:	TISSOT, KRISIN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(530) 816-1012
CITY:	CHESTER	STATE: CA	ZIP CODE:	96020
CAPACITY:	14	CENSUS:	DATE:	05/18/2022
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	11:35 AM
MET WITH:	Applicant, Kristin Tissot		TIME COMPLETED:	01:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	A prelicensing inspection was conducted today at 11:35am by Licensing Program Analyst (LPA), Kirk Marks. LPA met with applicant, Kristin Tissot. The applicant is requesting a license for a capacity of 14. The facility will operate Monday-Thursday, 8:00am to 5:00pm. The residence is a two bedroom/two bath single story home. There is one adult and no minors currently living in the home. The home and yard were toured, and the facility sketch was verified. The following areas will be off limits to children: One bedroom, one bathroom and laundry room. These areas have been made inaccessible by means of safety door knob covers. Poisons will be locked in the outdoor shed towards the back of the property. The home is equipped with a working smoke detector and fire extinguisher rated at least 2A10BC. The fireplace is securely screened with a safety gate/fence. The children will use the backyard/side yard as the outdoor play area. The yard is completely fenced. There is no pool, spa, pond, fountain, or any other body of water on the premises. LPA reviewed with applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Home, children’s forms/records, facility forms/records, and information to be posted. Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Kirk Marks	TELEPHONE: (530) 895-5045
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022

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: TISSOT, KRISTIN FAMILY CHILD CARE HOME	FACILITY NUMBER: 325408036
	VISIT DATE: 05/18/2022

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LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed applicant/licensee/facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.
To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

The following items need to be completed prior to the granting of license:

1. Railing on entry ramp will be completed.

Exit interview was conducted and report was reviewed with the applicant, Kristin Tissot.

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Kirk Marks	TELEPHONE: (530) 895-5045
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022

LIC809 (FAS) - (06/04)

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