525405399-7-23-2019-13-CC-PPAO-BECTAT-20190723143403

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 525405399
Report Date: 07/23/2019
Date Signed: 07/23/2019 02:34:29 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:	JIMENEZ, CINDY FAMILY CHILD CARE HOME		FACILITY NUMBER:	525405399
ADMINISTRATOR:	JIMENEZ, CINDY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(530) 838-8097
CITY:	CORNING	STATE: CA	ZIP CODE:	96021
CAPACITY:	14	CENSUS: 11	DATE:	07/23/2019
TYPE OF VISIT:	Annual/Required	UNANNOUNCED	TIME BEGAN:	01:35 PM
MET WITH:	Cindy Jimenez		TIME COMPLETED:	02:40 PM

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 required inspection was conducted at the facility by Licensing Program Analyst (LPA) Patricia Pacheco. A non-compliance conference was held with the licensee on 05/09/17, regarding violations of over capacity, improper napping of infants, and accessible hazards. A review of staff records 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 presently six adults living in the home. During today’s inspection the home and grounds were toured. The licensee and her assistant were supervising eleven children, and operating within the licensed capacity and ratio requirements. No children were observed left in any parked vehicle. The facility's operating hours 5:30am - 5:30pm, Monday-Friday. The off-limits kitchen, front sitting room and upstairs was inaccessible with a gate in the hallway and locked doors to the kitchen. Items that could pose a danger to children (cleaning supplies, etc) were inaccessible. Poisons are locked in a detached shop on the property. The home appeared clean and orderly and was at a comfortable indoor temperature. There is a working telephone in the home. The licensee's pediatric CPR and First Aid expire 5/20/19. The staircase is barricaded. There is a working smoke detector, carbon monoxide detector and fire extinguisher, rated at least 2A10BC, in the home. The licensee stated there are no firearms and/or other dangerous weapons in the home and none were observed during today's inspection. The children use a dedicated side yard as the outdoor play area and it is fully fenced. There is a pool in the off-limits area of the back yard that is fully fenced with a white vinyl perimeter fence and a five foot mesh pool fence that meets requirements. Eight children's records were reviewed R 2:05 pm and were observed to be in substantial compliance. The licensee is not

SUPERVISOR'S NAME: Erin Virrueta	TELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Patricia Pacheco	TELEPHONE: 530-895-5886
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2019

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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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: JIMENEZ, CINDY FAMILY CHILD CARE HOME	FACILITY NUMBER: 525405399
	VISIT DATE: 07/23/2019

NARRATIVE

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currently providing Incidental Medical Services – IMS. Incidental Medical Services (IMS) policy was discussed. 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. There were no Title 22 deficiencies cited during today's inspection.

Notice of Site Visit shall be posted for 30 days from today's visit.

SUPERVISOR'S NAME: Erin Virrueta	TELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Patricia Pacheco	TELEPHONE: 530-895-5886
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2019

LIC809 (FAS) - (06/04)

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