525407743-3-19-2025-13-CC-ECUL-DEWSZB-20250319141853

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 525407743
Report Date: 03/19/2025
Date Signed: 03/19/2025 02:19:39 PM

Document Has Been Signed on 03/19/2025 02:19 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
CHICO CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME:	MEDINA, CAMILLE FAMILY CHILD CARE HOME		FACILITY NUMBER:	525407743
ADMINISTRATOR/ DIRECTOR:	MEDINA, CAMILLE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	5305265148
CITY:	RED BLUFF	STATE: CA	ZIP CODE:	96080
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 4	DATE:	03/19/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:14 PM
MET WITH:	Noemi Tapia Reyes - assistant		TIME VISIT/ INSPECTION COMPLETED:	02:30 PM

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On 3/19/25 at 1:14pm, an annual inspection was made to the facility by Licensing Program Analyst (LPA), Emily Curiel and Sydney Sims. At 1:35pm the home was toured inside and outside. The assistant was supervising four children, and operating within the licensed capacity and ratio requirements. The facility’s operating hours are 7:30am -5:30pm and 2:30pm -5:30pm when school is in session for Red Bluff School district, Monday–Friday. The floor plan submitted by the licensee was reviewed and verified. The off-limits areas of the home are the master bedroom, kitchen, and bedrooms 1-2, and were made inaccessible by baby gate and door knob covers. The children use the back yard as the outdoor play area and it is fully fenced. There were no pools or other bodies of water observed in the yard

Four children's records were reviewed at 1:23pm. Two staff records were reviewed at 1:17pm. There are currently 2 adults living in the home.

The following deficiencies were cited: Licensee and assistant mandated reporter training is expired and signed of smoking observed in outdoor play area. (see LIC 809D)

Erin Virrueta	TELEPHONE: (530) 966-0216
Emily Curiel	TELEPHONE: (530) 980-4798
	DATE: 03/19/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025

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
CHICO CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: MEDINA, CAMILLE FAMILY CHILD CARE HOME	FACILITY NUMBER: 525407743
	VISIT DATE: 03/19/2025

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To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with assistant and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed assistant 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.

SUPERVISOR'S NAME: Erin Virrueta	TELEPHONE: (530) 966-0216
LICENSING EVALUATOR NAME: Emily Curiel	TELEPHONE: (530) 980-4798
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025

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
CHICO CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: MEDINA, CAMILLE FAMILY CHILD CARE HOME	FACILITY NUMBER: 525407743
	VISIT DATE: 03/19/2025

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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the assistant, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Camille Medina.

SUPERVISOR'S NAME: Erin Virrueta	TELEPHONE: (530) 966-0216
LICENSING EVALUATOR NAME: Emily Curiel	TELEPHONE: (530) 980-4798
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025

LIC809 (FAS) - (06/04)

Page: 2 of 4

Document Has Been Signed on 03/19/2025 02:19 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: MEDINA, CAMILLE FAMILY CHILD CARE HOME	FACILITY NUMBER: 525407743
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/19/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

CCR

102424(a)

Smoking Prohibition

(a) Smoking is prohibited on the premises of a family child care home as specified in Health and Safety Code Section 1596.795(a) This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above, Licensee had smoking butts outside where the children play which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/21/2025
	Plan of Correction
1 2 3 4	Licensee will statement acknowledging that Licensee will comply with the regulation of no smoking on the premises and send letter to LPA Sims by 4/21/25 via email to sydney.sims@dss.ca.gov

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above, Licensee and assistant do not have current manated reporter training which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/21/2025
	Plan of Correction
1 2 3 4	Licensee and Assistant will completed department approved Mandated reporter training and send copy of certificates to LPA Sims via email to sydney.sims@dss.ca.gov by 4/21/25

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Erin Virrueta	TELEPHONE: (530) 966-0216
Emily Curiel	TELEPHONE: (530) 980-4798
	DATE: 03/19/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025

LIC809 (FAS) - (06/04)

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