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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 515407295
Report Date: 05/23/2019
Date Signed: 05/23/2019 08:37:11 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:WASILCHIN, DAWN FAMILY CHILD CARE HOMEFACILITY NUMBER:
515407295
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 6DATE:
05/23/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:05 AM
MET WITH:Dawn WasilchinTIME COMPLETED:
08:45 AM
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Licensing Program Analyst (LPA) Martinez and Arnhold conducted an unannounced visit and met with licensee Dawn Wasilchin. Today's visit was conducted due to an increase of capacity application received in the office on 4/11/19. The LPA received a fire clearance on 5/22/19 at the regional office. During today's visit LPA's conducted a tour of the facility an on limits areas of the home. The home was observed clean and orderly and at a comfortable temperature. Based on observations of today's inspection, the increase of capacity is approved.

Notice of site visit must be posted for 30 days. No citations were issued during today's visit.
SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Mikah MartinezTELEPHONE: (530) 895-4014
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2019
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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