585404669-6-29-2021-13-CC-LCHZ-C4FUHB-20210629153541

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 585404669
Report Date: 04/06/2021
Date Signed: 06/29/2021 03:35:46 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:	VITAL, DELFINA FAMILY CHILD CARE HOME		FACILITY NUMBER:	585404669
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS:	DATE:	04/06/2021
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Delfina Vital		TIME COMPLETED:	08:30 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	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 3/26/2021. LPA met with Licensee Delfina Vital on 4/6/2021 at 8:00am. 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 4/5/2021 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, two adults reside in the home. The licensee is the property owner. The licensee operates 7 days a week;24 hours a day. 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 plan were reviewed. The licensee stated that no changes have been made to the facility floor and yard plans previously submitted on 3/28/2006. Sharps, cleaning supplies and chemicals, and medications are stored out of the reach of the children. Poisons are locked in the shed located in the backyard. The licensee stated that children have access to all rooms of the home including the converted garage. The licensee understands that children shall not be allowed to be in the converted garage if adequate heating or air conditioning is not provided. Report continued: See LIC 809-C

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura Chavez	TELEPHONE: (530) 895-5914
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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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: VITAL, DELFINA FAMILY CHILD CARE HOME	FACILITY NUMBER: 585404669
	VISIT DATE: 04/06/2021

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There is a working smoke detector, carbon monoxide detector and fire extinguisher, rated at least 2A10BC, in the home. The licensee stated there are no firearms and/or other dangerous weapons in the home, and none were observed during today's inspection. The children use the backyard as the outdoor play area. The backyard is completely fenced. The swing set located in the backyard is anchored to the ground and in good repair. There is no trampoline, pool, spa, pond, nor any other source of water accessible to the children. The licensee's CPR/First Aid expire 2/19/2023. 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 the Child Abuse Mandated Reporter Training.
https://mandatedreporterca.com/

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura Chavez	TELEPHONE: (530) 895-5914
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

LIC809 (FAS) - (06/04)

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