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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 515406371
Report Date: 06/11/2019
Date Signed: 06/12/2019 10:07:36 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:JUPINA, HILARY FAMILY CHILD CARE HOMEFACILITY NUMBER:
515406371
ADMINISTRATOR:JUPINA, HILARYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 617-5123
CITY:LIVE OAKSTATE: CAZIP CODE:
95953
CAPACITY:14CENSUS: 11DATE:
06/11/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Hilary JupinaTIME COMPLETED:
12:00 PM
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An inspection was made to the facility by Licensing Program Analyst (LPA) Martinez and Marks. A review of staff records on 6/10/19 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. There are currently 4 adults living in the home. During today’s inspection the home and grounds were toured. The licensee and two assistants were supervising 11 children, and operating within the licensed capacity and ratio requirements. No children were observed left in any parked vehicle. The facility’s operating hours are 7:30 to 5:30, Mon–Fri. The floor plan submitted by the licensee was reviewed and verified. The off-limits areas of the home are the downstairs bedroom, garage, the upstairs bedrooms, and were made inaccessible by door knob cover. The home was clean and orderly, and was at a comfortable indoor temperature. There is a working telephone in the home. The licensee has current pediatric CPR and First Aid certification, which expire on 5/15/20. Items which could pose a danger to children (such as detergents, cleaning compounds, medications, etc.) were stored out of the reach of children. Poisons are locked in the key locked garage. The staircase is barricaded with a gate at the foot of the stairs. There is a fireplace in the home that is not operable. There is a working smoke detector, carbon monoxide detector and fire extinguisher, rated at least 2A10BC, in the home. The licensee has a current roster of children in care. The licensee has conducted an emergency drill within the past six months, last drill was conducted on 2/6/19. The licensee stated there are firearms in the home and they were viewed stored and locked appropriately to Title 22 regulations. The home did not have a pool or body of water. The licensee is not providing Incidental Medical Services (IMS) to children in care. The Incidental Medical Services (IMS) policy was discussed with the licensee. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice 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, www.ada.gov/childqanda.htm. This report, as well as the AAP Guide to Safe Sleep Practices brochure, were reviewed and discussed with the licensee. All licensing reports are public information and must be made available upon request for at least three years.
Notice of Site Visit shall be posted for 30 days from today's visit.

There were no Title 22 deficiencies cited during today's inspection.
SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Mikah MartinezTELEPHONE: (530) 895-4014
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2019
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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