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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455408011
Report Date: 11/19/2021
Date Signed: 11/19/2021 01:51:31 PM

Document Has Been Signed on 11/19/2021 01:51 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:CHENEY, DEVON FAMILY CHILD CARE HOMEFACILITY NUMBER:
455408011
ADMINISTRATOR:CHENEY, DEVONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 356-3133
CITY:ANDERSONSTATE: CAZIP CODE:
96007
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
11/19/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Devon CheneyTIME COMPLETED:
10:20 AM
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 change of location inspection was conducted today by Licensing Program Analyst (LPA) Mendez The licensee is requesting a license for a capacity of up to 14. Fire clearance was granted on 11/17/21 Services will be provided Mon-Fri 7:30am - 5:30pm. The residence is a four bedroom/ two bath home. There are two adults currently living in the home. The applicant was advised that all adults residing or working at the facility must have a criminal background clearance on file with CCLD. 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.
Living room, kitchen, three bedrooms and one bathroom will be accessible. The master bedroom with master bathroom will be inaccessible with a lock on door knob and garage will be inaccessible with lock. Cleaning supplies are locked and stored under kitchen sink. Poisons are stored in laundry room locked. The sharp knives and medications are stored out of the reach of children. There are no firearms stored in the home; the LPA did not observe any weapons 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 and carbon monoxide detector. A fire extinguisher rated at least 2A10BC was observed.
The children will use the backyard as the outdoor play area and it is fully fenced.Backyard is currently under some work and front yard is currently some work. At this time it will not be accessible until further notice.
continued on 809C
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Bianca Mendez
LICENSING EVALUATOR SIGNATURE: DATE: 11/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2021
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: CHENEY, DEVON FAMILY CHILD CARE HOME
FACILITY NUMBER: 455408011
VISIT DATE: 11/19/2021
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
The licensee understood 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 understood that any authorized employee of the Department may enter and inspect the facility with or without advance notice. This report was reviewed and discussed with the applicant. Any proposed changes to the physical plant, telephone number, or change of address shall be immediately reported to the Department.


No citations were issued during today's visit.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Bianca Mendez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2