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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525407820
Report Date: 09/25/2023
Date Signed: 10/11/2023 03:10:02 PM

Document Has Been Signed on 10/11/2023 03:10 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
CHICO CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:CHAMBLIN, MELISSA FAMILY CHILD CARE HOMEFACILITY NUMBER:
525407820
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 11DATE:
09/25/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:22 PM
MET WITH:Melissa ChamblinTIME COMPLETED:
03:15 PM
NARRATIVE
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On 9/25/2023 at 1:12 p.m. an annual inspection was made to the facility by Licensing Program Analyst LPA, Julie Gifford At 1:22 p.m. the home was toured inside and outside. The licensee was supervising 11 children, with no assistant and was not operating within the licensed capacity and ratio requirements. The facility’s operating hours are 6:30 a.m.- 7 p.m. Monday–Friday. The floor plan submitted by the licensee was reviewed and verified. The off-limits areas of the home are 3 bedrooms, back yard, and dog area. These are made inaccessible by baby gates and locks. The children use a part of 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.

3 children's records were reviewed at 1:33 p.m and 1 staff records were reviewed at 1:47 p.m. There are currently 3 adults living in the home.

The following deficiencies were cited: a type A citation was cited for observation of loose articles (a pillow, blanket, and stuffed animal.) Located in the cribs where infants were sleeping. A type A citation was cited for the licensee exceeding the capacity specified on her license. (The licensee has a small family childcare home and was observed caring for 11 children, which exceeds the capacity of the license.) A type B citation was issued for the licensee not having a complete children's roster as required.

LPA Julie Gifford informed the licensee to provide a copy of this licensing report dated 9/25/2023 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. Continued on LIC 809-C.

SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Julie Gifford
LICENSING EVALUATOR SIGNATURE: DATE: 09/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/25/2023
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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Document Has Been Signed on 10/11/2023 03:10 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 10/05/2023 11:24 AM


Created By: Julie Gifford On 09/25/2023 at 02:07 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: CHAMBLIN, MELISSA FAMILY CHILD CARE HOME
FACILITY NUMBER: 525407820

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/25/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102425(g)
Infant Safe Sleep
An infant’s head shall not be covered while sleeping.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited by admitting to allowing infants to sleep with loose object and articles in their cribs at nap time and by LPA observation of 2 infants with a pillow, blanket, and stuffed animal in their cribs while sleeping. This presents an immediate risk to children in care.
POC Due Date: 09/26/2023
Plan of Correction
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The licensee will watch the safe sleep video on how to properly put infants to sleep, review safe sleep regulations and submit a written plan to the Department no later than close on business on 9/26/2023.
Type A
Section Cited
CCR
102416.5(a)
Staffing Ratio and Capacity
(a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited by admitting to caring for more children than the license allows and by LPA observation of the licensee caring for 11 children alone which exceeds the capacity of the small family child care home license. This presents an immediate risk to children in care.
POC Due Date: 09/26/2023
Plan of Correction
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The licensee will submit a written plan to the Department stating how to remain in compliance with capacity/ratio requirement to ensure no future citations occur to the no later than close of business on 9/26/2023.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Erin Virrueta
LICENSING EVALUATOR NAME:Julie Gifford
LICENSING EVALUATOR SIGNATURE:
DATE: 09/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/25/2023


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Document Has Been Signed on 10/11/2023 03:19 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 10/05/2023 11:43 AM


Created By: Julie Gifford On 09/25/2023 at 02:07 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: CHAMBLIN, MELISSA FAMILY CHILD CARE HOME
FACILITY NUMBER: 525407820

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/25/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(8)
Operation of A Family Child Care Home
(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited by admitting to not having a current/completed roster and by LPA observation of an outdated roster with missing information. This presents a potential risk to children in care.
POC Due Date: 09/26/2023
Plan of Correction
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The licensee will submit a copy of an updated and completed roster to include the names and contact information or all children in care by 10/9/2023.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Erin Virrueta
LICENSING EVALUATOR NAME:Julie Gifford
LICENSING EVALUATOR SIGNATURE:
DATE: 09/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/25/2023


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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
CHICO CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: CHAMBLIN, MELISSA FAMILY CHILD CARE HOME
FACILITY NUMBER: 525407820
VISIT DATE: 09/25/2023
NARRATIVE
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To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Continued on LIC 809-C.

SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Julie Gifford
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2023
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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
CHICO CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: CHAMBLIN, MELISSA FAMILY CHILD CARE HOME
FACILITY NUMBER: 525407820
VISIT DATE: 09/25/2023
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LPA discussed the safe sleep regulations with licensee] and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee [or facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When any IMS is provided, 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Melissa Chamblin.
SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Julie Gifford
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2023
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