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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525407536
Report Date: 05/21/2019
Date Signed: 05/21/2019 01:38:31 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:ROSALES, JENNIFER FAMILY CHILD CARE HOMEFACILITY NUMBER:
525407536
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
05/21/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Jennifer RosalesTIME COMPLETED:
01:45 PM
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A case management inspection was conducted by LPAs Chris Krogstad and Chris Arnhold. The licensee submitted and increase capacity application on 4/19/19 for a requested capacity of 14. The licensee has been licensed since 2012 at a different residence. This is a newly licensed residence that was licensed for 8 on 4/2/19. The approved fire clearance was received on 5/14/19. Landlord consent for 14 is on file. The review of the personnel report on 5/201/9 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 two adults living in the home.

During today's inspection the home and grounds were toured. The licensee was appropriately supervising four children. Services will be provided Mon-Fri, 7am-6pm. The floor plan submitted by the licensee was reviewed and verified. Children have access to the living room, kitchen, dining, second hallway bath, play room and back two bedrooms. The master bedroom is off-limits and inaccessible with a door knob cover. The home was clean and orderly. The wood stove was not in use during today's inspection. The sharp knives, cleaning supplies, medicines, are stored out of the reach of children. The licensee stated there are no firearms or ammunition stored on site and none were observed. The children in care will have access to age appropriate toys and equipment. The home is equipped with a working smoke detector, carbon monoxide detector and fire extinguisher rated at least 2A10BC. Children will use the fully fenced back yard as the outdoor play area. There were no bodies of water observed. The licensee's pediatric CPR/First Aid expire 11/2019. 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.
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. The increase capacity is granted.
SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Christen KrogstadTELEPHONE: (530) 895-4230
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2019
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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