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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 485407546
Report Date: 04/09/2021
Date Signed: 04/12/2021 08:10:27 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:NAEBKHEL, SURYA FAMILY CHILD CARE HOMEFACILITY NUMBER:
485407546
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: DATE:
04/09/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Licensee, Surya NaebkhelTIME COMPLETED:
02:45 PM
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The facility inspection was conducted via tele-inspection due to the current state of emergency regarding the COVID-19 outbreak.

Licensing Program Analyst (LPA) Kirk Marks conducted a licensee initiated case management pre licensing inspection in regards to an application for increased capacity that was received by the Department. The licensee had requested a capacity increase to 14 children.



The LPA toured the facilities indoor and outdoor area. The living room, one bedroom and bathroom are the accessible indoor areas. The licensee was supervising five children ages two through four during the tele-inspection. Licensee was operating within the limitations of her current license ratio. The LPA reviewed the ratios for a large license and the licensee acknowledged she understood the ratio requirements. The LPA also reviewed the Lead Exposure Testing Flyer with the licensee.

Based on the space/accommodations available at this facility and the fire marshal granting their approval (approved 4/02/2021) for the 14 children, the capacity increase request is granted. LPA will process this capacity increase and mail an updated license to reflect this capacity change to 14 children. An exit interview was conducted with Licensee.

Notice of Site Visit was given to licensee to post for 30 days.
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Kirk MarksTELEPHONE: (530) 895-5045
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2021
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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