525407648-4-23-2021-13-CC-LCHZ-C2CMJM-20210423093920

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 525407648
Report Date: 04/14/2021
Date Signed: 04/23/2021 09:39:46 AM

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:	FUENTES, ERIKA FAMILY CHILD CARE HOME		FACILITY NUMBER:	525407648
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 2	DATE:	04/14/2021
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Erika Fuentes		TIME COMPLETED:	03:45 PM

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	Licensing Program Analyst (LPA) Laura Chavez conducted a case management inspection in response to an application submitted by the licensee requesting an increase in capacity, the requested capacity is 14. An approved Fire Inspection Safety Request was received on 4/8/2021. LPA met with Licensee Erika Fuentes on 4/14/2021 at 3:00pm. The inspection was conducted via tele-inspection due to the current State of Emergency caused by COVID-19. During today's inspection a review of the COVID-19 Self-Assessment was made. A review of the Facility Personnel Report Summary dated 4/7/2021 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Currently, three adults reside in the home. The licensee is not the property owner. The licensee's days and hours of operation are Monday-Saturday; 6am-6pm. The licensee was reminded that 24-hour care shall not be provided to one child at any one time. During today’s inspection the home and grounds were toured. The floor and yard plans previously submitted/revised were reviewed. The living room, area next to the living room and bathroom are accessible to children in care. Areas off-limits include the three bedrooms, master bathroom and laundry room. These areas have been made off-limits by means of doorknob covers and gate. A gate has been placed around the wall heater located in the living room to prevent children from accessing. The licensee stated that only one wall heater is in the home. LPA did not observe additional wall heaters during today's tele-inspection. Sharps, cleaning supplies and chemicals, and medications are stored out of the reach of the children. Poisons are locked in the shop and storage buildings located in the backyard. There is a working smoke detector, carbon monoxide detector and fire extinguisher, rated at least 2A10BC, in the home. The licensee's CPR/First Aid expire 8/29/2021. The licensee stated there are no firearms and or other dangerous weapons in the home, and none were observed during today's inspection. Report continued: See LIC809-C

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura Chavez	TELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2021

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: FUENTES, ERIKA FAMILY CHILD CARE HOME	FACILITY NUMBER: 525407648
	VISIT DATE: 04/14/2021

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The children use the front yard as the outdoor play area. The front yard is completely fenced. There is no trampoline, pool, spa, pond, nor any other source of water accessible to the children. Gates prevent children from accessing the backyard. This report was discussed with the licensee. All licensing reports are public information and must be made available upon request for at least three years.

The following is required prior to granting the increase in capacity:
1. Proof of completion of Child Abuse Mandated Reporter Training.
2. Property Owner/Landlord Consent Form (LIC9149)

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura Chavez	TELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2021

LIC809 (FAS) - (06/04)

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