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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525407912
Report Date: 06/03/2022
Date Signed: 06/03/2022 12:29:17 PM


Document Has Been Signed on 06/03/2022 12:29 PM - It Cannot Be Edited

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:SIGUENZA-GUEVARA FAMILY CHILD CARE HOMEFACILITY NUMBER:
525407912
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 2DATE:
06/03/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Kari Siguenza-GuevaraTIME COMPLETED:
09:30 AM
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Licensing Program Analyst (LPA) Wisehart conducted a licensee initiated case management inspection in regard to an application for increased capacity that was received by the Department. The licensee had requested a capacity increase to 14 children. The facility operates Monday 7:00 am to Friday 5 pm.

At 8:45 am, the LPA toured the facilities indoor and outdoor areas. The LPA reviewed the indoor and outdoor floor plan and licensee made updates. Children have access to the Family room; Living room; Dining room and hallway bathroom and the Kitchen. The off-limit areas are the master bedroom/bathroom; two bedrooms and two bathroom and laundry room which are made inaccessible via door locks and gates. The outdoor play area is a fenced porch. The front yard grass area, if used as a play area will require 100% visual supervision which the license indicated she understood. The licensee and aid were supervising 2 children and was operating within the limitations of her current licensee ratio's. The LPA reviewed the ratios for a large license and the licensee acknowledged she understood the ratio requirements. The LPA also reviewed Provider Notice 22-10 issued March 18, 2022 Updated Guidance for Child Care Providers Regarding Coronavirus Disease.



Based on the space/accommodations available at this facility and the fire marshal granting their approval on 5/19/22 for 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: 06/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/03/2022
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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