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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525407848
Report Date: 11/30/2020
Date Signed: 10/21/2021 01:38:01 PM

Document Has Been Signed on 10/21/2021 01:38 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:PALOMINOS, MARIA FAMILY CHILD CARE HOMEFACILITY NUMBER:
525407848
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
11/30/2020
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Maria PalominosTIME COMPLETED:
04:45 PM
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On 11/30/2020 at 3:30pm, Licensing Program Analyst (LPA) Laura Chavez conducted prelicensing inspection in response to an application for a change of location, the requested capacity is 8. The inspection was conducted via tele-inspection due to the current State of Emergency caused by COVID-19. Days and hours of operation will be Monday-Friday; 6:00am-5:00pm. Three adults and one minor currently reside in the home. The licensee is not the homeowner. The Property Owner/Landlord Consent Form and Property Owner/Landlord Notification are on file. A review of the Facility Personnel Report Summary made indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. During today’s tele-inspection the home and grounds were toured. The floor and yard sketch previously submitted by the licensee were reviewed. No children were observed left in any parked vehicle. Notification of Parents Rights, Emergency Disaster Plan, with the Earthquake Preparedness Checklist shall posted. The residence is a three bedroom/one bath home. Rooms 1 and 2 designated on the facility sketch are off-limits to children. The third bedroom is designated as the "Kids Room". Doorknob covers prevent children from accessing Rooms 1 and 2. The home appears to be clean and orderly at this time and will remain so during child care hours. No cords to window blinds were observed. There is a working telephone. The sharp knives, cleaning supplies, medicines, are stored out of the reach of children. The licensee stated there are no poisons in the home and none were observed during today's inspection. The licensee understands that all poisons shall be locked if any are brought into the home. The licensee reports there are no weapons in the home and none were observed during the inspection. The children in care will have access to age appropriate toys and equipment.The home is equipped with a working smoke detector, and fire extinguisher rated at least 2A10BC. The carbon monoxide detector in the home is inoperable.

Report Continued: See LIC 809-C
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Laura Chavez
LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2020
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: PALOMINOS, MARIA FAMILY CHILD CARE HOME
FACILITY NUMBER: 525407848
VISIT DATE: 11/30/2020
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The children will use a sectioned off area of the back yard as their outdoor play area and is fully fenced. However, the fence that surrounds the outdoor play area is old and dilapidated and in the process of falling. Portions of the fence have been propped by strips of wood to keep the fence from falling. There is a shed located within the outdoor play area. During today's inspection the shed was observed to be empty. The licensee agrees to lock the shed if any poison or hazardous item is stored inside. There is a space between the shed and the fence that children could access and hide in. There is no trampoline, pool, or spa accessible to the children, and none of these items are to be added without prior notification and approval of the licensing agency. Forms and regulations may be accessed from the Department's website (www.ccld.ca.gov). Megan's Law is available at www.meganslaw.ca.gov/.

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

The following is required prior to granting a regular license:
1. Proof of a working a carbon monoxide detector.
2. Proof of completing training on lead prevention.
3. Proof of making back of shed inaccessible to children
4. Proof of securing the fence that surrounds the outdoor play area in a safe manner for children.
5. Proof of licensee's current vaccine against Influenza.
6. Completed copy of LIC508 for Vanessa Vargas.
7. Proof of TB clearance for Vanessa Vargas.
8. Proof of completing training on lead prevention.
9 Proof of current CPR/First Aid training.

A 90-day provisional licensee may be granted if items 1-8 are submitted.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Laura Chavez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2020
LIC809 (FAS) - (06/04)
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