Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045403296
Report Date: 02/09/2016
Date Signed 02/09/2016 02:05:17 PM

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:MONTES, ALMA & ANDREA FAMILY CHILD CARE HOMEFACILITY NUMBER:
045403296
ADMINISTRATOR:MONTES, ALMA & ANDREAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 892-2326
CITY:CHICOSTATE: CAZIP CODE:
95973
CAPACITY:14CENSUS: 11DATE:
02/09/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Alma and Andrea MontesTIME COMPLETED:
02:15 PM
NARRATIVE
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A visit was made to the facility by LPA, Dean Valencia. A review of staff records 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 presently 3 adults living in the home.

During today’s visit the home and grounds were toured and the licensee was operating within the licensed capacity. Operating hours are 6am to 5:30pm, Mon–Fri. The floor plan was verified. Off limits areas are inaccessible. There is a working telephone in the home. The licensee's pediatric CPR and First Aid are current, which expire 5/2016. Items which could pose a danger to children (detergents, cleaning compounds, and medications) were stored out of the reach of children. Poisons are locked in an outdoor shed. There is a working smoke detector, and fire extinguisher in the home. The facility did not have a carbon monoxide detector. The licensee has a current roster of children in care and has conducted an emergency drill within the past six months. The licensee stated there are no firearms and/or other dangerous weapons in the home and none were observed during today's visit. The children use the backyard as the outdoor play area and it is completely fenced. There are no bodies of water on the premises. Children's records were reviewed and in substantial compliance. 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.

The following violation(s) of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. Reports citing Type A violations are to be provided to parents/guardians of children currently in enrolled and to parents/guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must sign Form LIC9224 to be kept in each child's file.
SUPERVISOR'S NAME: Lisa McKayTELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Dean ValenciaTELEPHONE: (530) 895-4322
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2016
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: MONTES, ALMA & ANDREA FAMILY CHILD CARE HOME
FACILITY NUMBER: 045403296
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/09/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/10/2016
Section Cited
H&S 1596.954
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Carbon monoxide detectors. Every licensed child day care center shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections.

Facility did not have a carbon monoxide detector.
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Licensee will submit photo proof of carbon monoxide detector installed, on 2/10/2016.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Lisa McKayTELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Dean ValenciaTELEPHONE: (530) 895-4322
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2016
LIC809 (FAS) - (06/04)
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