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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455404876
Report Date: 12/16/2019
Date Signed: 12/17/2019 07:46:58 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:GUIN, JEANETTE FAMILY CHILD CARE HOMEFACILITY NUMBER:
455404876
ADMINISTRATOR:GUIN, JEANETTEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 347-5547
CITY:COTTONWOODSTATE: CAZIP CODE:
96022
CAPACITY:14CENSUS: 9DATE:
12/16/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Jeanetter GuinTIME COMPLETED:
02:30 PM
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LPA's Wisehart and Snow conducted a Case Management visit on 12/26/19 and met with Licensee, Jeanette Guin. The LPA's observed 2 staff supervising 9 children in care and they were operating within capacity and ratio requirements. During today's inspection the home and grounds were toured. The condition of the home was orderly. The LPA observed in the yard, the kiddie pool is inside a fenced area and the gate was open at the time of visit, however, the pool was upside down with no water. The Licensee indicated she had dogs on site which may bite but that they are locked up when children are present or when they use the yard play area.

The LPA's handed out a brochure on the use of safe equipment, Safe Sleep and Shaken Baby Syndrome.


There were no Title 22 deficiencies cited during today’s inspection. Notice of Site Visit shall be posted for 30 days from today’s date. An exit interview was conducted.
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Carrie WisehartTELEPHONE: (530) 895-5824
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2019
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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