<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045407916
Report Date: 06/21/2021
Date Signed: 06/21/2021 06:03:42 PM

Document Has Been Signed on 06/21/2021 06:03 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:QUESADA, NICOLE FAMILY CHILD CARE HOMEFACILITY NUMBER:
045407916
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
06/21/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
05:10 PM
MET WITH:Nicole QuesadaTIME COMPLETED:
06:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
A pre-licensing inspection was conducted on 6/21/2021 at 5:10pm by Licensing Program Analyst (LPA), Emilia Grisak. The applicant is requesting a license for a capacity of 8. Services will normally be provided 24 hours a day/7 days a week. The applicant understands that no one child may be cared for consecutively for 24 hours or longer. The applicant understands that child care must be provided in the "primary" residence of the applicant. The residence is a three bedroom/two bath home. Applicant was advised that all adults residing or working at the facility must have a criminal background clearance on file with CCLD. All minors residing in the home must be fingerprinted within 30 days of reaching their 18th birthday and obtain a TB clearance. The applicant is aware of the immediate $100 per day civil penalty for adults working or residing in the home without a criminal record clearance.

The main bedroom and bathroom are off limits to the children. These areas have been made inaccessible by means of door knob covers. The home appears to be clean and orderly at this time and will remain so during child care hours. There is a working telephone. There are no sharp knives present, and cleaning supplies are stored out of the reach of children. There are no poisons present but licensee was advised that they must be locked if present. The applicant reports there are no weapons in the home and none were observed during the visit. The children in care will have access to age appropriate toys and equipment. The home is equipped with a working smoke detector, carbon monoxide detector and fire extinguisher rated at least 2A10BC. There is no fireplace or open heater present. The children will eventually use the front yard as the outdoor play area. However, at this time the front yard is not yet accessible to children in care and applicant will install a fence or barrier to prevent children from accessing a small ledge which leads to garden area. The front yard is completely fenced. The backyard area is off limit to children in care. There is a trampoline in the backyard off-limit area that is not to be used by daycare children during daycare hours. There is no pool, spa, pond, fountain, nor any other source of water accessible to the children, and none is to be added without prior notification and approval of the licensing agency.
SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Emilia Grisak
LICENSING EVALUATOR SIGNATURE: DATE: 06/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/21/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: QUESADA, NICOLE FAMILY CHILD CARE HOME
FACILITY NUMBER: 045407916
VISIT DATE: 06/21/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Parents will be required to sign insurance affidavits if the provider does not plan to purchase additional child care liability insurance. Proof of control of property is on file. Parent's rights are posted. Emergency drills must be conducted at least once every six months and the date documented. Children's records to be maintained were reviewed. The roster is to remain current at all times. Unusual Incident Report procedures were explained, to include notification before close of next business day and follow-up with written report within seven days. The applicant was using First Aid/CPR Waiver previously and was advised that First Aid/CPR certification must be obtained now that State of Emergency is over. The applicant shall be present in the home and shall ensure that children in care are supervised by a fingerprinted adult with current Pediatric CPR and First Aid certification. The applicant understands that children may only be transported by adults with a criminal record clearance and are never to be left unattended in a vehicle. The applicant clearly understands the maximum number of children for whom care can be provided and the limitations on the number of infants (birth to age 2) that may be cared for and when two of the children in care must be school aged. Smoking is prohibited during the hours of operation in those areas where children are present.

The applicant understands the responsibility to read and have knowledge of the laws and regulations for operation of a family child care home. Forms and regulations must be obtained from the website. http://ccld.ca.gov/
Megan's Law web site was provided (http://www.meganslaw.ca.gov). The licensee understands that any authorized employee of the Department may enter and inspect the facility with or without advance notice. Guide to Safe Sleeping Practices pamphlet and the Lead Exposure Testing flyer were discussed with the applicant.

Any proposed changes to the physical plant, telephone number, or change of address shall be immediately reported to the Department.

The applicant shall be granted a 90-day Provisional License.

Prior to granting a regular license the following is required:
1. Proof of current certification of Preventative Health Practices
2. Proof of current CPR/First Aid
SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Emilia Grisak
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2