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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 515408063
Report Date: 02/28/2022
Date Signed: 03/14/2022 02:13:36 PM

Document Has Been Signed on 03/14/2022 02:13 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:TENA-FARFAN, MONICA FAMILY CHILD CARE HOMEFACILITY NUMBER:
515408063
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 2DATE:
02/28/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Monica Tena-FarfanTIME COMPLETED:
02:50 PM
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A prelicensing inspection was conducted today at 1:35pm by Licensing Program Analyst (LPA), Laura Chavez. LPA met with applicant Monica Tena-Farfan. The applicant is requesting a license for a capacity of 8. The facility will operate Monday-Friday, 7am to 5:00pm. The residence is a three bedroom/two bath single story home.There are two adults and two minors currently living in the home. The licensee is the homeowner. A review of the Facility Personnel Report Summary made on 2/27/2022 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 inspection the home and grounds were toured, and the facility sketch was verified. The home appears to be clean and orderly at this time and will remain so during child care hours. No children were observed left in any parked vehicle. Notification of Parents Rights, Emergency Disaster Plan, with the Earthquake Preparedness Checklist shall be posted. The following areas will be off limits to children: master bedroom and bath and additional bedroom in the homes. These areas have been made inaccessible by means of doorknob covers. Poisons are locked in the garage. The home is equipped with a working smoke detector, carbon monoxide detector and fire extinguisher rated at least 2A10BC. The children will use a gated area to the side of the home 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.

Report Continued: See LIC 809-C
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Laura Chavez
LICENSING EVALUATOR SIGNATURE: DATE: 02/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/28/2022
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: TENA-FARFAN, MONICA FAMILY CHILD CARE HOME
FACILITY NUMBER: 515408063
VISIT DATE: 02/28/2022
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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.

LPA discussed the safe sleep regulations with applicant/licensee/facility representative 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 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.

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

Exit interview conducted and report was reviewed with the applicant Monica Tena-Farfan.

SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Laura Chavez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2022
LIC809 (FAS) - (06/04)
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