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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045407916
Report Date: 07/01/2022
Date Signed: 07/01/2022 02:55:50 PM

Document Has Been Signed on 07/01/2022 02:55 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: 8CENSUS: 3DATE:
07/01/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Nicole QuesadaTIME COMPLETED:
02:00 PM
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Licensing Program Analyst, Emilia Grisak conducted a case management inspection on 7/1/22 at 1:50pm. This inspection was in response to an application for increased capacity that was received by the Department on 6/28/22. The licensee has requested a capacity increase to 14 children.

The LPA toured the facility's indoor and outdoor areas. The off-limits areas of the home are the main bedroom and bathroom and have been made inaccessible by use of door knob covers. The children use the front yard as the outdoor play area and it is fully fenced. There were no pools or other bodies of water observed in the yard. The licensee was supervising 3 children at the time of the visit, and was operating within capacity. The LPA reviewed the ratio's for a large license and the licensee acknowledged she understood the ratio requirements. The LPA also reviewed the Safe Sleep requirements with provider although the provider does not currently have infants enrolled and the provider has an assistant.



Based on the space/accommodations available at this facility and the fire marshal granting their approval on 6/30/22 for the 14 children, the capacity increase request is granted. LPA will process this capacity increase and mail an updated license to reflect this capacity change to 14 children. An exit interview was conducted with licensee.

Notice of Site Visit was given to licensee to post for 30 days.
SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Emilia Grisak
LICENSING EVALUATOR SIGNATURE: DATE: 07/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/01/2022
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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