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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525407604
Report Date: 08/29/2019
Date Signed: 08/29/2019 01:59:49 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:ELLYATT, MIRANDA FAMILY CHILD CARE HOMEFACILITY NUMBER:
525407604
ADMINISTRATOR:ELLYATT, MIRANDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 736-8705
CITY:RED BLUFFSTATE: CAZIP CODE:
96080
CAPACITY:14CENSUS: 0DATE:
08/29/2019
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Miranda EllyattTIME COMPLETED:
02:05 PM
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A change of location prelicensing inspection was conducted today by LPA, Chris Krogstad. The licensee is requesting a license for a capacity of 14 in her new residence. Services will be provided Mon-Fri 7am -5:30pm. The residence is a three bedroom, 1.5 bath home. There is one adult and three minors living in the home. All adults residing in the home or working with children have criminal background clearances on file with the Department. There was no evidence of any excluded individuals living in the home. The approved fire clearance for the requested capacity was received on 8/16/19.

Children will have access to the entire home. The licensee understands any changes to the use of the home shall be reported to the Department with an updated floor/yard plan. The bedroom in the back converted shop will be off-limits and inaccessible with a locked door. The home is clean and orderly at this time and will remain so during child care hours. There is a working telephone. The sharp knives, cleaning supplies, medicines, are stored out of the reach of children. The licensee stated no firearms or ammunition are 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 backyard as the outdoor play area and it is fully fenced. Poisons are locked in the laundry room closet. The licensee understands that items that could pose a danger to children shall be made inaccessible to children. There were no bodies of water observed. The licensee is not providing Incidental Medical Services – IMS, at this time. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. A Plan for Providing IMS must be submitted to the Department if IMS is provided. The following information regarding ADA was provided: US Department of Justice (USDOJ) 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, available at: www.ada.gov/childqanda.htm. The licensee has completed the required Mandated Reporter Training on 11/7/18 and has current pediatric CPR and First Aid (expire 12/20). The licensee understands that any authorized employee of the Department may enter and inspect the facility with or without advance notice. This report was reviewed and discussed with the licensee. New Infant Regulations and Guide to Safe Sleeping Practices was discussed. Any proposed changes to the physical plant, telephone number, or change of address shall be immediately reported to the Department.

The home is ready for licensure. The change of location license is granted.
SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Christen KrogstadTELEPHONE: (530) 895-4230
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2019
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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