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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455407933
Report Date: 07/12/2021
Date Signed: 07/12/2021 02:19:37 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:MANN, KIM FAMILY CHILD CARE HOMEFACILITY NUMBER:
455407933
ADMINISTRATOR:MANN, KIMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 228-4679
CITY:REDDINGSTATE: CAZIP CODE:
96002
CAPACITY:14CENSUS: 0DATE:
07/12/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Kim MannTIME COMPLETED:
11:35 AM
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A change of location inspection was conducted today by LPA Mendez on 7/12/21 at 11:10am. This inspection was conducted in person The licensee is requesting a license for a capacity of 14. Services will be provided Mon-Fri 7:00 -5:30pm The residence is a three bedroom/ two bath home. There is one adult currently 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 kitchen, bathroom, living room, garage and other two bedrooms, the master bedroom/bathroom is off limits. The garage has been converted to a play area for children with a/c. Household cleaners are stored in a locked shed located outdoors. The sharp knives and medications are stored out of the reach of children. 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. 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.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 always to remain current . 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: 07/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2021
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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