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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045408039
Report Date: 02/02/2022
Date Signed: 02/02/2022 11:00:03 AM

Document Has Been Signed on 02/02/2022 11:00 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
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:TIEDEMANN FAMILY CHILD CARE HOMEFACILITY NUMBER:
045408039
ADMINISTRATOR:TIEDEMANN, SHANNONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 518-3717
CITY:OROVILLESTATE: CAZIP CODE:
95966
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
02/02/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Shannon & Daniel TiedemannTIME COMPLETED:
11:10 AM
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A pre-licensing inspection visit was conducted today by LPA, Emilia Grisak. The applicants are requesting a license for a capacity of 14. Services will be provided Monday -Friday; 6:30am – 5:30pm. The applicant sunderstands that child care must be provided in the "primary" residence of the applicant. The residence is a four bedroom/two bath home. There are two adults living in the home. 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 applicants are aware of the immediate $100 per day civil penalty for adults working or residing in the home without a criminal record clearance.

All of the bedrooms including master bedroom and master bath, the hall closet, outdoor shed, and separate side yard are off limits to the children. These areas have been made inaccessible by means of locks and baby gates. The home appears to be clean and orderly at this time and will remain so during child care hours. There is a working telephone present. The sharp knives, cleaning supplies and medicines are stored out of the reach of children. Applicants stated that if poisons are present they are stored in the outdoor locked shed. There are weapons stored in the home and weapons and ammunition are stored according to Title 22 regulations. 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 children will primarily use the backyard and the front yard is also available as the outdoor play areas. The backyard and front yard are completely fenced. There is no trampoline on the premises. There is no pool, spa, pond, fountain, nor any other source of water accessible to the children, and none is to be added without prior notification and approval of the licensing agency.
SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Emilia Grisak
LICENSING EVALUATOR SIGNATURE: DATE: 02/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/02/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: TIEDEMANN FAMILY CHILD CARE HOME
FACILITY NUMBER: 045408039
VISIT DATE: 02/02/2022
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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. Proof of control of property is on file. Parent's rights will be posted on magnet board in dining room area. 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 applicants will maintain current on Pediatric CPR and First Aid and current CPR/FA expires on 10/11/23. The applicants 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 applicants 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 applicants 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. Smoking is prohibited during the hours of operation in those areas where children are present.

The applicants 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. LPA discussed the safe sleep regulations with applicants and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.

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

The following needs to be completed prior to the issue of license.

1. Complete mandated reporter training
2. Remove fencing from backyard
SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Emilia Grisak
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022
LIC809 (FAS) - (06/04)
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