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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 515407295
Report Date: 03/12/2020
Date Signed: 03/12/2020 03:09:51 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:WASILCHIN, DAWN FAMILY CHILD CARE HOMEFACILITY NUMBER:
515407295
ADMINISTRATOR:WASILCHIN, DAWNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 778-3155
CITY:YUBA CITYSTATE: CAZIP CODE:
95991
CAPACITY:14CENSUS: 8DATE:
03/12/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Dawn WasilchinTIME COMPLETED:
03:15 PM
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An inspection was made to the facility by Licensing Program Analyst (LPA), Martinez. A review of staff records on 3/10/20 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 2 adults living in the home. During today’s inspection the home and grounds were toured. The licensee and one assistant children were supervising 8 children and operating within the licensed capacity and ratio requirements. The off limits areas of the home are the entire upstairs of the home, the two downstairs bedroom and the , and were made inaccessible by gate. The home was observed to be clean and orderly, and was at a comfortable indoor temperature. There were safe toys and equipment available for children. The licensee stated there is a working telephone in the home. The licensee’s pediatric CPR and First Aid certifications were reviewed, and expire on 1/22. Items which could pose a danger to children were observed to be stored out of the reach of children. Poisons were locked in the locked laundry. The stairs/staircase beginning at the foot of the living room were barricaded with a gate. The fireplace has been made inaccessible with a screen. The LPA observed a working smoke detector, carbon monoxide detector and fire extinguisher, rated at least 2A10BC, in the home. The roster of children in care was reviewed and was current. The licensee has conducted an emergency drill within the past six months, last drill was documented on 2/24/20. The licensee stated there are firearms in the home and they were observed to be stored appropriately during today's inspection. The children use the backyard as the outdoor play area and it is fully fenced. There is an in ground pool and above ground spa in the back yard. The pool is fully fenced with appropriate Title 22 Fencing. Five children's records were reviewed at 2:50PM; current immunizations and Notification of Parent’s Rights forms were on file. 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: 03/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2020
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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