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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525407820
Report Date: 12/20/2023
Date Signed: 12/20/2023 10:50:45 AM

Document Has Been Signed on 12/20/2023 10:50 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
CHICO CC RO, 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: 5DATE:
12/20/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:17 AM
MET WITH:Melissa ChamblinTIME COMPLETED:
11:00 AM
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Licensing Program Analyst LPA's J.Gifford and E.Laird, conducted a case management facility inspection on 12/20/23 at 10:17 AM. This inspection was in response to an application for increased capacity. The application was received by the Department on 10/09/23. The licensee requested a capacity increase to 14 children.

LPA toured the facility's indoor and outdoor areas. The off limits areas of the home are three bedrooms and the living room are made inaccessible by baby gates. The children use the back yard as the outdoor play area, and it is fenced. There were no pools or other bodies of water observed in the yard. The LPA reviewed the staff ratio for a large license and the licensee acknowledged she understood the ratio requirements. The LPA also reviewed the Safe Sleep requirements with provider. Licensee's CPR/First Aid expires 11/15/2025. Mandated Reporter Certificate expires 12/16/2025.

Local fire authority approved fire clearance on 11/22/2023.

As of today’s date, 12/20/2023, the capacity increase request is granted. An exit interview was conducted with licensee.

SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Julie Gifford
LICENSING EVALUATOR SIGNATURE: DATE: 12/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/20/2023
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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