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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 475407558
Report Date: 10/05/2021
Date Signed: 10/05/2021 04:08:11 PM

Document Has Been Signed on 10/05/2021 04:08 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:HERRERA, YESSENIA FAMILY CHILD CARE HOMEFACILITY NUMBER:
475407558
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
10/05/2021
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Yessenia Herrera, LicenseeTIME COMPLETED:
01:00 PM
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On 10/05/21, Licensing Program Analyst (LPA) N. Cunningham visited the Family Child Care Home (FCCH) to conduct a required inspection. Upon arrival, the licensee stated that a household member tested positive for Covid19 on 09/27/21. As of today, the licensee has not contacted public health to seek guidance. LPA Cunningham provided Siskiyou County Public Health phone number and requested the licensee contact them immediately. LPA Cunningham also requested that the licensee contact her and advise the direction public health provided. LPA Cunningham did not enter the home due to the positive case. The licensee stated she currently has three children in care. Licensee's signature is not on file, however, a copy of this Facility Evaluation Report (LIC 809) was provided to Licensee; and confirmation of receipt is on file.
SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Nicolette Cunningham
LICENSING EVALUATOR SIGNATURE: DATE: 10/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/05/2021
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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