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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 475406362
Report Date: 08/08/2019
Date Signed: 08/08/2019 12:02:58 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:ROTH, PEGGY FAMILY CHILD CARE HOMEFACILITY NUMBER:
475406362
ADMINISTRATOR:ROTH, PEGGYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 598-8805
CITY:YREKASTATE: CAZIP CODE:
96097
CAPACITY:14CENSUS: 8DATE:
08/08/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Peggy RothTIME COMPLETED:
12:15 PM
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A Plan of Correction inspection was made to the facility by Licensing Program Analysts (LPA), Snow & Marks who met with Licensee, Peggy Roth as a follow up on violations issued on 6/12/19. The LPA's reviewed the children's files for the required documentation which was complete. The Licensee was operating within ratio during todays inspection; she was careing for 8 children and one was an infant and at least 2 were school aged. No children were observed sleeping on this day; the car seat was observed to be empty and the Licensee stated that she understands it can not be used during child care hours.

The facility was issued a Type A violation on 6/12/19 and today the LPA observed proof that the parents/guardians of the children in care today have a signed Form LIC9224 that was kept in each child's file. Peggy Roth is aware that she must continue this for all children including newly enrolled children for one year from the citation (6/12/20)

No violations were issued today.

SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Jaime SnowTELEPHONE: (530) 215-6132
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2019
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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