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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 115408351
Report Date: 08/30/2023
Date Signed: 08/30/2023 08:34:58 AM

Document Has Been Signed on 08/30/2023 08:34 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:ULLOA, GRACIELA FAMILY CHILD CARE HOMEFACILITY NUMBER:
115408351
ADMINISTRATOR:ULLOA, GRACIELAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 865-2195
CITY:ORLANDSTATE: CAZIP CODE:
95963
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
08/30/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
07:52 AM
MET WITH:Graciela UlloaTIME COMPLETED:
08:44 AM
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A location change/prelicensing inspection was conducted today at 7:52 PM by Licensing Program Analyst (LPA) Mendez. LPAs met with applicant/licensee Graciela Ulloa. The applicant/licensee is requesting a license for a capacity of 14 and fire clearance was granted on 8/18/23. The facility will operate Monday-Friday, 4:00 AM to 5:00 PM. The residence is a 4 bedroom/2 bath home. The home and yard were toured, and the facility sketch was verified. The following areas will be off limits to children: the garage. These areas have been made inaccessible by means of door lock. The home is equipped with a working smoke detector and fire extinguisher rated at least 2A10BC. The children will utilize the backyard as the main play area, and it is fenced completely. No bodies of water were observed in the yard. The applicant/licensee understands that constant supervision must be provided while children are outside in unfenced areas. LPA reviewed with applicant/licensee 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/Licensee 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.

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SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Bianca Mendez
LICENSING EVALUATOR SIGNATURE: DATE: 08/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2023
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: ULLOA, GRACIELA FAMILY CHILD CARE HOME
FACILITY NUMBER: 115408351
VISIT DATE: 08/30/2023
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LPA discussed the safe sleep regulations with applicant/licensee 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 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.

The following items need to be completed prior to the granting the license:

1. Proof of Preventative Health Practices (PHP).
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Bianca Mendez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023
LIC809 (FAS) - (06/04)
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