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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
115405057
Report Date:
12/01/2021
Date Signed:
12/14/2021 02:03:58 PM
Document Has Been Signed on
12/14/2021 02:03 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:
FERNANDEZ, MARIA FAMILY CHILD CARE HOME
FACILITY NUMBER:
115405057
ADMINISTRATOR:
FERNANDEZ, MARIA
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(530) 965-2691
CITY:
ORLAND
STATE:
CA
ZIP CODE:
95963
CAPACITY:
14
TOTAL ENROLLED CHILDREN:
14
CENSUS:
2
DATE:
12/01/2021
TYPE OF VISIT:
Case Management - Licensee Initiated
UNANNOUNCED
TIME BEGAN:
09:15 AM
MET WITH:
Maria Fernandez
TIME COMPLETED:
09:40 AM
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A case management Licensee initiated inspection was conducted by Licensing Program Analyst (LPA) Mendez in response to a new floor plan submitted by licensee. Licensee had added additional room to the house that will be used as the daycare room and will the inside of the house will continue to be accessible to children. Daycare room entrance is on the side of the house accessible by a side gate. Daycare room has bathroom accessible to children. The floor plan was submitted by licensee and verified. A fire clearance for the room was granted on 11/15/21. Electrical outlets were covered. The fire extinguisher is rated at least 2A-10 BC and located on the wall. Cleaning supplies are kept locked in the garage and in a locked cabinet. There is a working smoke detector and carbon monoxide detector in the daycare room. Clearance is granted for licensee to use daycare room for children
.
SUPERVISORS NAME
:
Megan Aviles
LICENSING EVALUATOR NAME
:
Bianca Mendez
LICENSING EVALUATOR SIGNATURE
:
DATE:
12/01/2021
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/01/2021
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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