<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 115407609
Report Date: 10/14/2020
Date Signed: 03/30/2023 09:23:02 PM

Document Has Been Signed on 03/30/2023 09:23 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:REYNOSO, ROSALINA FAMILY CHILD CARE HOMEFACILITY NUMBER:
115407609
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
10/14/2020
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Rosalina ReynosoTIME COMPLETED:
03:15 PM
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
On 10/14/2020 at 2:30pm, Licensing Program Analyst (LPA) Laura Chavez conducted a Case Management inspection with applicant Rosalina Reynoso. The inspection was conducted via tele-inspection due to the current State of Emergency caused by COVID-19. The inspection is a follow-up to the prelicensing inspection made on 1/23/2020. Currently, four adults and one minor reside in the home. A review of the Facility Personnel Report Summary dated 10/16/2020 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. During today’s inspection the home and grounds were toured. The floor and yard sketch previously submitted by the licensee was reviewed. No children were observed left in any parked vehicle. Notification of the Parents Rights, Emergency Disaster Plan, with the Earthquake Preparedness Checklist shall be posted. The residence is a three bedroom/two bath home. The bedrooms including the master bathroom and laundry room are off-limits to children. Locks and doorknob covers have been installed making these areas inaccessible to children. The home appears to be clean and orderly at this time and will remain so during child care hours. No cords to window blinds were observed. There is a working telephone. The sharp knives, cleaning supplies, medicines, are stored out of the reach of children. The applicant reports there are no weapons in the home and none were observed during the inspection. 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.

Report continued: See LIC809-C
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Laura Chavez
LICENSING EVALUATOR SIGNATURE: DATE: 10/14/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/14/2020
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: REYNOSO, ROSALINA FAMILY CHILD CARE HOME
FACILITY NUMBER: 115407609
VISIT DATE: 10/14/2020
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
26
27
28
29
30
31
32
The children will use the enclosed area adjacent to the home as their outdoor play area. The debris from the fenced off backyard has been removed as requested during the initial prelicensing inspection.This area is off-limits to children in care. The applicant understands that visual supervision is required if the gate to the driveway is not closed. There is no trampoline, pool, or spa accessible to the children, and none of these items are to be added without prior notification and approval of the licensing agency.

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

The applicant will be issued a 90-day Provisional License.

The following is required prior to granting a regular license:
1. Proof of current CPR/First Aid certification.
2. Proof of training in prevention of lead exposure.
3. Proof of Child Abuse Mandated Reporter training.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Laura Chavez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2020
LIC809 (FAS) - (06/04)
Page: 2 of 2