045407621-4-20-2023-13-CC-JSNW-CQTNRZ-20230412104222

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 045407621
Report Date: 04/12/2023
Date Signed: 04/20/2023 11:47:47 AM

Document Has Been Signed on 04/20/2023 11:47 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME:	BOLANOS GUTIERREZ, CRISTAL FAMILY CHILD CARE HOME		FACILITY NUMBER:	045407621
ADMINISTRATOR:	BOLANOS GUTIERREZ, CRISTAL		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(530) 353-1498
CITY:	OROVILLE	STATE: CA	ZIP CODE:	95966
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 8	DATE:	04/12/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Gutierrez		TIME COMPLETED:	11:00 AM

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On April 12, 2023 at 8:30am an annual inspection was made to the facility by Licensing Program Analyst (LPA), Snow. This program is operated from 8 am to 5 pm, Monday–Friday. The facility was toured at 930am inside and outside and the floor and yard plan submitted by the licensee were verified. Facility operates in the entire building.

The licensee, was supervising 8 children, and operating within the licensed capacity and ratio requirements. There are no pools or bodies of water on the premises. The upstairs is off limits except for the bathroom.

Five children's records were reviewed at 945am. 3 staff records were reviewed at 10am.

Licensee, Guiterrez Bolanos was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department.

SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Jaime Snow
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023

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
CHICO-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: BOLANOS GUTIERREZ, CRISTAL FAMILY CHILD CARE HOME	FACILITY NUMBER: 045407621
	VISIT DATE: 04/12/2023

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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

There were no deficiencies cited during today’s inspection

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Guiterrez Bolanos.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Jaime Snow
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023

LIC809 (FAS) - (06/04)

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