515408075-3-31-2022-13-CC-BMEZ-CD34RN-20220331192014

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 515408075
Report Date: 03/30/2022
Date Signed: 03/31/2022 07:21:25 PM

Document Has Been Signed on 03/31/2022 07:21 PM - It Cannot Be Edited

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:	RAYA, RACHEL FAMILY CHILD CARE HOME		FACILITY NUMBER:	515408075
ADMINISTRATOR:	RAYA, RACHEL		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(530) 923-9224
CITY:	YUBA CITY	STATE: CA	ZIP CODE:	95991
CAPACITY:	14	CENSUS: 0	DATE:	03/30/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Rachel Raya		TIME COMPLETED:	10:30 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	A prelicensing inspection was conducted today at 9:30am by Licensing Program Analyst (LPA), Mendez and LPA Helton. LPA met with applicant/licensee Rachel Raya. The applicant is requesting a change of location license for a capacity of 14. The facility will operate Monday-Saturday, 4:00am to 11:00pm. A fire clearance was granted on 3/29/22. The residence is a 3 bedroom, 2 bathrooms, one story home. There are four adults and one minor in the home The home and yard were toured, and the facility sketch was verified. The following areas will be off limits to children: Three bedrooms, master bathroom and garage will be inaccessible to children These areas have been made inaccessible by means of locking child gate and door knob covers. Poisons will be locked in the garage. The home is equipped with a working smoke detector and fire extinguisher rated at least 2A10BC. The licensee stated the fireplace will not be utilized during child care hours and it is covered with a screen. The children will use the backyard as the outdoor play area. The backyard is completely fenced. There is no pool, spa, pond, fountain, or any other body of water on the premises. LPA reviewed with applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Home, children’s forms/records, facility forms/records, and information to be posted. Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Bianca Mendez	TELEPHONE: (530) 895-4357
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: RAYA, RACHEL FAMILY CHILD CARE HOME	FACILITY NUMBER: 515408075
	VISIT DATE: 03/30/2022

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LPA discussed the safe sleep regulations with applicant/licensee/facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed applicant/licensee/facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.
To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the applicant/licensee Rachel Raya.

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Bianca Mendez	TELEPHONE: (530) 895-4357
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022

LIC809 (FAS) - (06/04)

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