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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525407591
Report Date: 08/11/2021
Date Signed: 08/11/2021 10:59:30 AM

Document Has Been Signed on 08/11/2021 10:59 AM - 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:DAVIS, ROXANNE FAMILY CHILD CARE HOMEFACILITY NUMBER:
525407591
ADMINISTRATOR:DAVIS, ROXANNEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 704-6381
CITY:RED BLUFFSTATE: CAZIP CODE:
96080
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 7DATE:
08/11/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Roxanne DavisTIME COMPLETED:
10:15 AM
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On 8/11/2021 at 9 am, an annual inspection was made to the facility by Licensing Program Analyst (LPA), Wisehart. A review of staff records on 8/11/2021 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 currently is one adult living in the home.

At 9:30 am the home was toured inside and outside. The licensee and staff (S1) were supervising 7 children, and operating within the licensed capacity and ratio requirements. The facility’s operating hours are 24/7 however, the licensee understands that she can't provide consecutive care. Licensee is closed on Sundays. The floor plan submitted by the licensee was reviewed and verified. Children have access to the entire home, except the front two bedrooms that were inaccessible via locks, however one of the locks was broken and will be repaired or a door knob cover will be placed on the door otherwise the room will be considered accessible. Poisons are locked in the garage. Items which could pose a danger to children (detergents, cleaning compounds, medications, etc.) are stored out of the reach of children. There is a working smoke detector, carbon monoxide detector and fire extinguisher, rated at least 2A10BC, in the home. The licensee stated there are no firearms and/or other dangerous weapons in the home, and none were observed during today's inspection The home is clean, orderly and comfortable. There are safe toys and equipment available for children. There is a working telephone in the home.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Carrie Wisehart
LICENSING EVALUATOR SIGNATURE: DATE: 08/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/11/2021
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: DAVIS, ROXANNE FAMILY CHILD CARE HOME
FACILITY NUMBER: 525407591
VISIT DATE: 08/11/2021
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The licensee currently has no infants enrolled. The licensee would provide cribs/play yards for napping infants if one enrolled. Cribs will have firm mattresses and will be free of loose objects. Children's bedding is laundered weekly, and soiled bedding is stored inaccessible to children. Napping infants will be checked on every 15 minutes, and checks will be documented on a safe sleep log. No infants were observed to be swaddled, and infants under 12 months are placed on their backs for sleeping.

The children use the back yard as the outdoor play area and it is fully fenced. There were no pools or other bodies of water observed in the yard.

4 children's records were reviewed at 9:17 am; required emergency information forms were observed to be on file. The licensee has completed Mandated Reporter training but will be renewing her certificate. The licensee has the required immunization's on file, however, staff (S1) needs measles and pertussis records on file. The licensee has current pediatric CPR and First Aid certification, which expire on 2/2023.

The LPA discussed COVID Guidance; Safe Sleep and the Lead Flyer.

This report was reviewed and discussed with the licensee. All licensing reports are public information and must be made available upon request for at least three years.

Notice of Site Visit shall be posted for 30 days from today's visit.

There were no Title 22 deficiencies cited during today's inspection though advisories were given.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Carrie Wisehart
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2021
LIC809 (FAS) - (06/04)
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