525407743-4-30-2020-13-CC-CWIT-BP6KAS-20200430074423

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 525407743
Report Date: 04/28/2020
Date Signed: 04/30/2020 07:44:29 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:	MEDINA, CAMILLE FAMILY CHILD CARE HOME		FACILITY NUMBER:	525407743
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	04/28/2020
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Camille Medina		TIME COMPLETED:	10:00 AM

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	The facility pre-licensing inspection was conducted via tele-inspection due to the current state of emergency regarding the COVID-19 outbreak by Licensing Program Analyst, Wisehart. The applicant is requesting a license for a capacity of 8. Services will be available 7:30 am - 6:00 pm Monday - Friday. The residence is a two bedroom, one bath home. The applicant is the only individual living in the home. The applicant was advised that all adults residing or working at the facility must have a criminal background clearance on file with CCLD. All minors residing in the home must be fingerprinted within 30 days of reaching their 18th birthday and obtain a TB clearance. The applicant is aware of the immediate $100 per day civil penalty for adults working or residing in the home without a criminal record clearance. Children will have access to the playroom; dining room; living room; the bathroom and two bedrooms. The off limits areas are the kitchen and one bedroom/laundry room off kitchen, which is gated. The poisons/chemicals are locked and stored in medicine cabinet in master bedroom which LPA confirmed during the tour. The applicant understands that poisons shall be kept locked. This is a single level home. There is no staircase. The home appears clean and orderly at this time and will remain so during child care hours. There is a fireplace which has a wood insert which is not being used. The licensee understand that if the wood insert is used in the future, a secured fence will need to be placed around it. There is a working telephone. The sharp knives, cleaning supplies, medicines, are stored out of the reach of children. The applicant stated no firearms or ammunition is 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. The applicant stated children will use the backyard as the outdoor play area and it is fully fenced. There were no bodies of water observed on the property, though a plastic kid size portable pool was observed leaning against a fence and licensee stated it maybe used during day care hours under 100 supervision and immediately emptied after each use. The applicant currently is not providing Incidental Medical Services and does not intend to accept those with medical needs. The Licensee understand the need to file an IMS plan with CCL if she in the future accepts a child with those needs. 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: http://www.ada.gov/childqanda.htm.

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Carrie Wisehart	TELEPHONE: (530) 895-5824
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2020

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: MEDINA, CAMILLE FAMILY CHILD CARE HOME	FACILITY NUMBER: 525407743
	VISIT DATE: 04/28/2020

NARRATIVE

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Parents will be required to sign insurance affidavits if the provider does not plan to purchase additional child care liability insurance. Control of property and landlord consent is on file. Parent's rights poster is posted. Emergency drills must be conducted at least once every six months and the date documented. Children's records to be maintained were reviewed. The roster is to remain current at all times. Unusual Incident Report procedures were explained, to include notification before close of next business day and follow-up with written report within seven days. The applicant will maintain current on Pediatric CPR and First Aid (expires 8/2021) as well as Mandated Reporter Training (expires 4/17/22). The applicant shall be present in the home and shall ensure that children in care are supervised by a fingerprinted adult with current Pediatric CPR and First Aid certification. The applicant understands that children may only be transported by adults with a criminal record clearance and are never to be left unattended in a vehicle. The applicant clearly understands the maximum number of children for whom care can be provided and the limitations on the number of infants (birth to age 2) that may be cared for and when two of the children in care must be school aged. During the State of Emergency the ratios are 1:4 infants (0-18 months) and 1:6 (2 infants and 4 children). Smoking is prohibited at all times in those areas where childcare is provided. The Licensee understands that the use of baby walkers, bouncers or similar items are not approved equipment for use in licensed child care homes.

The applicant understands the responsibility to read and have knowledge of the laws and regulations for operation of a family child care home. Forms and regulations must be obtained from the website. http://ccld.ca.gov/. Megan's Law web site was provided (http://www.meganslaw.ca.gov). 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 applicant. Guide to Safe Sleeping Practices pamphlet and the Lead Exposure Testing was discussed with the applicant.

Any proposed changes to the physical plant, telephone number, or change of address shall be immediately reported to the Department.

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Carrie Wisehart	TELEPHONE: (530) 895-5824
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2020

LIC809 (FAS) - (06/04)

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