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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525407820
Report Date: 11/03/2021
Date Signed: 11/03/2021 02:07:12 PM

Document Has Been Signed on 11/03/2021 02:07 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:CHAMBLIN, MELISSA FAMILY CHILD CARE HOMEFACILITY NUMBER:
525407820
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 7DATE:
11/03/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Melissa ChamblinTIME COMPLETED:
12:15 PM
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On 11/3/21 at 10:50 am, an annual inspection was made to the facility by Licensing Program Analyst (LPA), Wisehart. A review of staff records on 11/3/21 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. There are currently two adults living in the home.

At 11:05 am the home was toured inside and outside. The licensee was supervising 7 children, and operating within the licensed capacity and ratio requirements. The facility’s operating hours are 7 am - 5:30 pm , Monday–Friday. The floor plan submitted by the licensee was reviewed and verified. There off limit areas inside the home include master bedroom and one child's bedroom.
The poisons/chemicals are stored in the locked storage unit in the off limit dog yard area, which LPA confirmed during the tour. Items which could pose a danger to children (detergents, cleaning compounds, medications, etc.) are stored out of the reach of children. The facility has no fireplace but it has a wall furnace with a secured fence around it. There is a working smoke detector, carbon monoxide detector and fire extinguisher, rated at least 2A10BC, in the home. The licensee stated there are no firearms and/or other dangerous weapons in the home, and none were observed during today's inspection The home is clean, orderly and comfortable. There are safe toys and equipment available for children. There is a working telephone in the home.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Carrie Wisehart
LICENSING EVALUATOR SIGNATURE: DATE: 11/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/03/2021
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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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: CHAMBLIN, MELISSA FAMILY CHILD CARE HOME
FACILITY NUMBER: 525407820
VISIT DATE: 11/03/2021
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There are cribs/play yards available for napping infants. Cribs have firm mattresses and are free of loose objects. Bedding is laundered weekly, and soiled bedding is stored inaccessible to infants. Napping infants are checked on every 15 minutes, and checks are to be logged on an Infant Sleep Schedule. No infants were observed to be swaddled, and infants under 12 months are placed on their backs for sleeping.

The Licensee stated children use the back yard as a play area it is fully fenced. The back yard entry is from the front yard area. There were no pools or other bodies of water observed in the yard.

Four children's records were reviewed at 11:10 am and the required emergency information forms were observed to be on file. Individual Sleeping Plans were on file for infants under 12 months of age. The licensee has completed Mandated Reporter training (expires 12/17/22. The licensee and all employees have the required immunization's on file. The licensee has current pediatric CPR and First Aid certification, which expire on 10/22. The LPA provided the latest COVID Guidance.

This report was reviewed and discussed with the licensee. All licensing reports are public information and must be made available upon request for at least three years.

Notice of Site Visit shall be posted for 30 days from today's visit.

There were no Title 22 deficiencies cited during today's inspection though advisories were issued.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Carrie Wisehart
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021
LIC809 (FAS) - (06/04)
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