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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 115407609
Report Date: 11/19/2021
Date Signed: 11/19/2021 02:18:32 PM

Document Has Been Signed on 11/19/2021 02:18 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: 8CENSUS: 3DATE:
11/19/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Rosalina ReynosoTIME COMPLETED:
02:20 PM
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On 11/19/2021 at 1"50pm LPA Laura Chavez conducted a case management inspection to the facility in response to an application submitted by the licensee requesting an increase in capacity. The requested capacity is 14. An approved fire safety inspection was received on 10/29/2021. The licensee is the property owner. The licensee operates Monday-Friday, 6am-5pm, Saturday's as needed. The floor and yard plan were reviewed. The licensee added Bedroom #3 as the children's playroom. An updated facility sketch was received on 9/28/2021 to indicate Bedroom #3 as an additional area accessible to children. There is a working smoke detector, carbon monoxide detector and fire extinguisher, rated at least 2A10BC, in the home. The licensee's CPR/First Aid expire 12/20/2022. 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.

Notice of Site Visit shall be posted for 30 days from today's visit.

The facility is in substantial compliance with Title 22 regulations. The increase in capacity is thereby granted.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Laura Chavez
LICENSING EVALUATOR SIGNATURE: DATE: 11/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2021
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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