525407520-8-5-2021-13-CC-CWIT-C5LT6T-20210805142737

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 525407520
Report Date: 08/05/2021
Date Signed: 08/05/2021 02:27:42 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:	MEDINA, ELIZABETH FAMILY CHILD CARE HOME		FACILITY NUMBER:	525407520
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	08/05/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Elizabeth Medina and Martha Medina		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	On 8/5/21 at 9:20 am, an annual inspection was made to the facility by Licensing Program Analyst (LPA), Wisehart. A review of staff records on 8/5/21 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 3 adults living in the home. At 9:30 am the home was toured inside and outside. The licensee had no children in care today but claims to be operating within the licensed capacity and ratio requirements. The facility’s operating hours are 5 am – 6 pm, Monday–Friday. The floor plan submitted by the licensee was reviewed and verified. The off-limits areas of the home are the upstairs portion of the home, and were made inaccessible by gate at bottom of stairs. Poisons are in laundry room/car port but was unlocked at time of visit due to misplaced key but no children were in care. Licensee will install new lock with key. Items which could pose a danger to children (detergents, cleaning compounds, medications, etc.) are stored out of the reach of children. The facility has an electrical fireplace and licensee understands if it's used a fire fence would need to be installed. 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 home is clean, orderly and comfortable. Stairs are inaccessible via gates. There are safe toys and equipment available for children. There is a working telephone in the home.

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Carrie Wisehart	TELEPHONE: (530) 895-5824
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021

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: MEDINA, ELIZABETH FAMILY CHILD CARE HOME	FACILITY NUMBER: 525407520
	VISIT DATE: 08/05/2021

NARRATIVE

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The facility current has no infants enrolled but are planning on getting cribs/play yards upon enrollment of any napping infants. Cribs will have firm mattresses and will be free of loose objects. Children's bedding is laundered weekly, and soiled bedding is stored inaccessible to children. Napping infants will be checked on every 15 minutes, and licensee understand that the checks are to be documented . No infants will be swaddled, and infants under 12 months will be placed on their backs for sleeping.The children use the front yard as the outdoor play area, and it is fully fenced, however middle fence dividing accessible and inaccessible areas was removed due to recent cement project and has not been replaced yet. The LPA observed at 9:40 am 2 bottles of lighter fluid and 7 gallon paint cans. No children were in care a the time and licensee has plan to replace fence within days, prior to the return of children. The licensee is to immediately lock up poisons and if play area is used prior to fence installation 100% supervision will be required until fence is reinstalled. There were no bodies of water observed. The side and backyard are off-limits and inaccessible with gates and the gate in the entryway of the kitchen.

2 children's records were reviewed at 9:49 am; required emergency information forms were observed to be on file. No infants are currently enrolled but licensee understands that Individual Sleeping Plans would need to be on file for infants under 12 months of age. The licensees Mandated Reporter training expired 1/9/19 and licensee will enroll to renew class. The licensee and all employees have the required immunization's on file. The licensee has an expired (7/7/20) pediatric CPR and First Aid certification but is enrolled in a class on 8/14/21. The licensee's last fire drill was on 10/16/14 which is expired so licensee will completed a new drill the next time children are in care.

This report was 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 but advisories were issued.

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Carrie Wisehart	TELEPHONE: (530) 895-5824
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021

LIC809 (FAS) - (06/04)

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