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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 485408313
Report Date: 06/19/2023
Date Signed: 06/19/2023 10:40:04 AM

Document Has Been Signed on 06/19/2023 10:40 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:WHITE, CHARLOTTE FAMILY CHILD CARE HOMEFACILITY NUMBER:
485408313
ADMINISTRATOR:WHITE, CHARLOTTEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 290-6874
CITY:DIXONSTATE: CAZIP CODE:
95620
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
06/19/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Charlotte WhiteTIME COMPLETED:
10:45 AM
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A prelicensing inspection was conducted today at 9:30am by Licensing Program Analyst (LPA), Laura Chavez. LPA met with licensee Charlotte White. The inspection is done in response to the licensee's request for a change of of location. The licensee is requesting a license for a capacity of 14. An approved fire inspection was received on 6/1/2023. The facility will operate Sunday-Saturday, 3:00am to 11:00pm. The residence is a 4 bedroom/3.5 bath two story home. Currently 2 adults and 4 minors reside in the home.

The home and yard were toured, and the facility sketch was verified. The following areas will be off limits to children: The second floor of the home and the garage. These areas have been made inaccessible by means of a digital lock on the garage door and gates at the bottom and top of the stairs. Licensee stated there are no poisons in the home. During today's inspection LPA did not observe any poisons in the home. The licensee understands that all poisons are to be locked should any are brought into the home. The home is equipped with a working smoke detector and fire extinguisher rated at least 2A10BC. 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 licensee Charlotte White 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.

SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Laura Chavez
LICENSING EVALUATOR SIGNATURE: DATE: 06/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/19/2023
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: WHITE, CHARLOTTE FAMILY CHILD CARE HOME
FACILITY NUMBER: 485408313
VISIT DATE: 06/19/2023
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The 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.

LPA discussed the safe sleep regulations with Licensee Charlotte White and discussed the Child Care Licensing Safe Sleep web page at:https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-
sleep as an additional resource. LPA also informed 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 home is ready for licensure.

A exit interview was conducted and report was reviewed with licensee Charlotte White.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Laura Chavez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2023
LIC809 (FAS) - (06/04)
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