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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525407520
Report Date: 05/13/2022
Date Signed: 05/13/2022 09:52:38 AM


Document Has Been Signed on 05/13/2022 09:52 AM - 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:MEDINA, ELIZABETH FAMILY CHILD CARE HOMEFACILITY NUMBER:
525407520
ADMINISTRATOR:MEDINA, ELIZABETHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 209-1384
CITY:CORNINGSTATE: CAZIP CODE:
96021
CAPACITY:14CENSUS: 4DATE:
05/13/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Elizabeth MedinaTIME COMPLETED:
09:15 AM
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A Plan Of Correction visit was made on 5/13/22 by Licensing Program Analyst (LPA), Wisehart who met with the licensee, Elizabeth Medina. The LPA toured the facility both inside and outside at 8:45 am The LPA observed that the requested changes to the playground equipment had been complete. The licensee removed the loose nails/screws; and covered up exposed sharp ends of screws and tightened up all screw connections; and cleaned out spider webs and attached the loose boards before children used the structure.

Therefore, citation 102417(d) - Operation of a Family Child Care Home - The home shall provide safe toys, play equipment and materials has been met and cleared during today's visit.

The LPA also revised the language on the Case Management visit which had been conducted on 5/11/22.

No citations were cited during today's visit. A notice of site visit must be posted for 30 days.
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Carrie WisehartTELEPHONE: (530) 895-5824
LICENSING EVALUATOR SIGNATURE:
DATE: 05/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/13/2022
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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