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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 115408179
Report Date: 01/13/2023
Date Signed: 01/13/2023 09:16:39 AM

Document Has Been Signed on 01/13/2023 09:16 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:VAZQUEZ, GUADALUPE FAMILY CHILD CARE HOMEFACILITY NUMBER:
115408179
ADMINISTRATOR:VAZQUEZ, GUADALUPEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 520-4017
CITY:ORLANDSTATE: CAZIP CODE:
95963
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
01/13/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:22 AM
MET WITH:Guadalupe VazquezTIME COMPLETED:
09:26 AM
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A prelicensing inspection was conducted today at 8:22am by Licensing Program Analyst (LPA), Mendez. LPA met with applicant Guadalupe Vazquez. The applicant is requesting a license for a capacity of 14. The facility will operate Monday-Friday, 5 am to 6 pm. The residence is a 3 bedroom/ 2 bath single story home. All adults living in the home are cleared.

The home and yard were toured, and the facility sketch was verified. The following areas will be off limits to children: master bedroom/bathroom and two bedrooms and garage. These areas have been made inaccessible by means of door knob covers. The home has a garage converted daycare room with ac/heat which will be off limits for the time. There are no poisons in the home and if applicant were to have any they understand that it needs be in a locked cabinet. home is equipped with a working smoke detector and fire extinguisher rated at least 2A10BC. The fireplace is securely screened with black metal screen. The fireplace is electric and currently not in use since it does not function. The children will use the backyard as the outdoor play area. The backyard is completely fenced. There is no pool, spa, pond, fountain, or any other body of water on the premises.

LPA reviewed with applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Home, children’s forms/records, facility forms/records, and information to be posted.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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 licensed Family Child Care Home. 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.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Bianca Mendez
LICENSING EVALUATOR SIGNATURE: DATE: 01/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/13/2023
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
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: VAZQUEZ, GUADALUPE FAMILY CHILD CARE HOME
FACILITY NUMBER: 115408179
VISIT DATE: 01/13/2023
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LPA discussed the safe sleep regulations with applicant 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. LPA also informed applicant/licensee/facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.
To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.



Exit interview conducted and report was reviewed with the applicant Guadalupe Vazquez
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Bianca Mendez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2023
LIC809 (FAS) - (06/04)
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