Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455400688
Report Date: 11/25/2015
Date Signed: 11/25/2015 11:20:19 AM

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:GIBSON-CASSIDY, ELAINE FAMILY DAY CAREFACILITY NUMBER:
455400688
ADMINISTRATOR:GIBSON-CASSIDY, ELAINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 605-0930
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY:14CENSUS: 18DATE:
11/25/2015
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Elaine Gibson-CassidyTIME COMPLETED:
11:30 AM
NARRATIVE
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(3) A visit was made to the facility by LPA, Jordan Monath. 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. There were 18 children in care at the beginning of this visit. The licensee was over capacity for approximately 20 minutes until 4 children were picked up.

During today’s visit the home and grounds were toured and the facility was operating within the licensed capacity. Licensee stated normal operating hours are all hours, Monday – Sunday. The floor plan was verified. The off limit areas were inaccessible. The home appeared clean and orderly. There is a working telephone in the home. There was a working smoke detector, carbon monoxide sensor, and fire extinguisher in the home. The licensee's poisons were locked in an outdoor cabinet. The licensee stated no weapons are on the property and none were observed during this visit. The children use the backyard as the outdoor play area. There is an existing waiver allowing alternative (slats) fencing to make the swimming pool inaccessible. The conditions of the waiver were in place during this visit. Children's records were reviewed and required documents were present. The licensee has a current roster of children in care and has conducted an emergency drill within the last 6 months. All licensing reports are public information and must be made available upon request for at least three years. Reports citing Type A violations are to be provided to parents/guardians of children currently enrolled and to parents/guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must sign Form LIC 9224 to be kept in each child's file.
Notice of Site Visit shall be posted for 30 days from today's visit.

The following violation of the California Code of Regulations, Title 22; Division 12, was observed: see LIC 809D.
SUPERVISOR'S NAME: Lisa McKayTELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Jordan MonathTELEPHONE: (530) 513-1214
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2015
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: GIBSON-CASSIDY, ELAINE FAMILY DAY CARE
FACILITY NUMBER: 455400688
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/25/2015
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/30/2015
Section Cited
102416.5(a)
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Staffing Ratio and Capacity. The capacity specified on the license shall be the maximum number of children for whom care.

There were 18 children in care. This presents an immediate risk to the health and safety of children in care.
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The licensee was within ratio prior to the end of this visit and the licensee agrees to provide a written statement on how she will ensure operation within her licensed capacity.

The plan of correction shall be submitted to CCLD on or before 11/30/15.
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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: Jordan MonathTELEPHONE: (530) 513-1214
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2015
LIC809 (FAS) - (06/04)
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