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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455407343
Report Date: 10/01/2020
Date Signed: 03/30/2023 09:24:19 PM

Document Has Been Signed on 03/30/2023 09:24 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:MADRIGAL, MARIA FAMILY CHILD CARE HOMEFACILITY NUMBER:
455407343
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
10/01/2020
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Maria Madrigal TIME COMPLETED:
05:05 PM
NARRATIVE
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On 10/1/2020 at 3:30pm, Licensing Program Analyst (LPA) Laura Chavez conducted a case management inspection in response to an application received for an increase in capacity to 14. The inspection was conducted via tele-inspection due to the current State of Emergency caused by COVID-19. Days and hours of operation will be Monday-Friday; 5am-5pm. Currently, five adults reside in the home. A review of the Facility Personnel Report Summary made on 10/1/2020 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 tele-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 Parents Rights, Emergency Disaster Plan, with the Earthquake Preparedness Checklist are posted. The residence is a three bedroom/three bath home. The three bedrooms, master bathroom and bathroom #2, kitchen, utility room and playroom are off-limits to children. Retractable gates prevent children accessing areas designated as off-limits. 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. Poisons are locked in the shop which is located outside of the fenced in outdoor play area. The alarms on windows having direct access to the irrigation canal were tested and in working order.
Report continued: See LIC 809-C
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Laura Chavez
LICENSING EVALUATOR SIGNATURE: DATE: 10/01/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/01/2020
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: MADRIGAL, MARIA FAMILY CHILD CARE HOME
FACILITY NUMBER: 455407343
VISIT DATE: 10/01/2020
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The licensee reports there are no weapons in the home and none were observed during the visit. 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. The licensee has current pediatric CPR and First Aid certification, which expire on 2/21/2021. The children use the enclosed area adjacent to the home in the back yard as their outdoor play area and is fully fenced. A waiver on file allows for a five foot non-climbable fence around the outdoor play area and alarms/rail locks on on doors and windows which allow direct access to the irrigation canal. The licensee was reminded of keeping her child care roster current at all time. The licensee will continue to conduct and document emergency disaster drills at least once every six months. 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. Forms and regulations may be accessed from the Department's website (www.ccld.ca.gov). Megan's Law is available at www.meganslaw.ca.gov/.

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

The following is required prior to increasing capacity:
1. Approved Fire Safety Inspection.
2. Updated facility sketch.
3. Proof of current Child Abuse Mandated Reporter Training.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Laura Chavez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2020
LIC809 (FAS) - (06/04)
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