Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045404706
Report Date: 06/03/2016
Date Signed 06/03/2016 03:26:26 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:WILLIAMS, MELISSA FAMILY CHILD CARE HOMEFACILITY NUMBER:
045404706
ADMINISTRATOR:WILLIAMS, MELISSAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 342-6676
CITY:CHICOSTATE: CAZIP CODE:
95973
CAPACITY:14CENSUS: 0DATE:
06/03/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Melissa WilliamsTIME COMPLETED:
03:35 PM
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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 2 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. The wood stove has a secured screen. The licensee's pediatric CPR and First Aid is current, which expires 2/2017. 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 the outdoor shop. There is a working smoke detector, carbon monoxide detector and fire extinguisher in the home. 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 firearms and ammunition are locked separately. There is a swimming pool and spa, in the back section of the backyard. The pool is inaccessible, and fencing meets Title 22 Regulations. Spa is completely locked. Children's records were reviewed and in substantial compliance. IMS-Incidental Medical Services were discussed. 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 visit.

SUPERVISOR'S NAME: Jordan MonathTELEPHONE: (530) 895-5948
LICENSING EVALUATOR NAME: Dean ValenciaTELEPHONE: (530) 895-4322
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2016
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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