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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525407520
Report Date: 08/05/2021
Date Signed: 08/05/2021 02:28:22 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 HOMEFACILITY NUMBER:
525407520
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
08/05/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Elizabeth Medina and Martha MedinaTIME COMPLETED:
11:20 AM
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The facility inspection was conducted by Licensing Program Analyst (LPA) Wisehart . The visit was a licensee initiated case management pre licensing inspection in regard to an application for increased capacity that was received by the Department. The licensee had requested a capacity increase to 14 children.

The LPA toured the facilities indoor and outdoor areas. Children have access to the living room, and downstairs master bedroom and bath. The upstairs is off-limits and barricaded with a gate at the bottom of the staircase. The kitchen is off-limits with a gate in the entry way. The licensee was supervising no children at the time of the visit but claimed that when open she is operating within the limitations of her current licensee ratio's. The LPA reviewed the ratios for a large license and the licensee acknowledged she understood the ratio requirements. The LPA printed and reviewed Safe Sleep regulations, Lead Exposure Testing flyer and COVID-19 guidance with the licensee.



Based on the space/accommodations available at this facility and the fire marshal granting their approval on 8/3/21, for the 14 children, the capacity increase request is granted once the following has been completed;
1. Mandated Reporter Certificate is renewed
2. CPR/First Aid Card is renewed
3. Laundry Room chemicals have a true locking device
4. Play yard area has all chemicals removed and locked. The Play yard will require 100% supervision until the middle fence section has been reinstalled.
Upon receipt of items, the LPA will process this capacity increase and mail an updated license to reflect this capacity change to 14 children. An exit interview was conducted with Licensee.
Notice of Site Visit was given to licensee to post for 30 days.
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Carrie WisehartTELEPHONE: (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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