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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525407743
Report Date: 04/06/2021
Date Signed: 04/12/2021 02:16:03 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:MEDINA, CAMILLE FAMILY CHILD CARE HOMEFACILITY NUMBER:
525407743
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 6DATE:
04/06/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Camille MedinaTIME COMPLETED:
02:00 PM
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The facility inspection was conducted via tele-inspection due to the current state of emergency regarding the COVID-19 outbreak by Licensing Program Analyst, Wisehart.

The Case Management inspection was in response to an application for increased capacity that was received by the Department. The licensee has requested a capacity increase to 14 children. Licensee is current on CPR/First Aid (expires 8/21); Mandated Reporter Training (expires 4/17/22) and has taken the Preventative Health Practices class on 11/18/17 with the added lead portion on 1/30/21.



The LPA toured the facilities indoor and outdoor areas. The playroom, dining room/living room and hallway bathroom and corner bed room are the accessible indoor areas. The inaccessible areas include the kitchen; extra bedroom and masterbed/bathroom which had gates and door knob covers. The licensee was supervising 6 children at the time of the tele visit, and she was operating within the limitations of her current license ratio's. The LPA reviewed the ratio's for a large license and the licensee acknowledged she understood the ratio requirements. The LPA also reviewed the Safe Sleep and Lead Exposure Testing Flyer with the licensee.

Based on the space/accommodations available at this facility and the fire marshal granting their approval on 3/30/21 for the 14 children, the capacity increase request is granted. LPA will process this capacity increase and mail an updated license to reflect this capacity change to 14 children. An exit interview was conducted with licensee.

Notice of Site Visit was given to licensee to post for 30 days.
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Carrie WisehartTELEPHONE: (530) 895-5824
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2021
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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