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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 485407842
Report Date: 03/17/2021
Date Signed: 03/17/2021 05:13:17 PM

Document Has Been Signed on 03/17/2021 05:13 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:MIRAMONTES, CATALINA FAMILY CHILD CARE HOMEFACILITY NUMBER:
485407842
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 1DATE:
03/17/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:03 AM
MET WITH:Catalina MiramontesTIME COMPLETED:
11:37 AM
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The facility prelicensing inspection was conducted via tele-inspection due to the current state of emergency regarding the COVID-19 outbreak by Licensing Program Analyst Mendez The applicant is requesting to be licensed for a small family childcare. Operational hours are 7:00 AM to 5:30 PM, Monday - Friday. The residence is a three bedroom/two and half bath, two story home with an attached garage. There are two adults living in the home and one minor. The applicant was advised that all adults residing or working at the facility must have a criminal background clearance on file with Community Care Licensing Department. 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 civil penalty for adults working or residing in the home without a criminal record clearance.
Children will enter the home from the front door of the house. Living room and bathroom is accessible to children. Areas that are not accessible to children are the kitchen blocked with a child gate, dining room, garage, master bedroom, and two rooms located upstairs. Stairs are blocked with a child gate.The sharp knives, cleaning supplies, and medicines will are stored out of the reach of children. Poisons are locked and stored in the garage. The children in care will have access to age appropriate toys and equipment. The children will use the yard that is fully fenced for outdoor play and require supervision at all times. No bodies of water observed on the premises. The home is equipped with a working smoke detector and carbon monoxide detector fire extinguisher rated at least 2A10BC was observed in the home. Homeowner is insured and expected to carry liability insurance.. The licensee stated there are firearms in the home, licensee showed that firearm and ammunition are locked separately.The home appeared to be clean and orderly at this time and will remain so during child care hours. There is a working telephone in the home and a first aid is available. Parent bulletin with postings is posted by the entrance of the door.

The applicant may intend to provide Incidental Medical Services – IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. A Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.
SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Bianca Mendez
LICENSING EVALUATOR SIGNATURE: DATE: 03/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/17/2021
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: MIRAMONTES, CATALINA FAMILY CHILD CARE HOME
FACILITY NUMBER: 485407842
VISIT DATE: 03/17/2021
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The applicant may obtain liability insurance and will provide the department with a copy of the insurance once decided. Parent's rights poster will be 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 will remain current on Pediatric CPR and First Aid. 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 at all times in those areas where childcare is provided.

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. This report was reviewed and discussed with the applicant. Guide to Safe Sleeping Practices pamphlet was provided and discussed.


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

The following items need to be sent to the office before being licensed
1. Facility sketch of upstairs room
SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Bianca Mendez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2021
LIC809 (FAS) - (06/04)
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