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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 585407983
Report Date: 09/14/2021
Date Signed: 09/14/2021 02:11:04 PM

Document Has Been Signed on 09/14/2021 02:11 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:SOTO, ANA FAMILY CHILD CARE HOMEFACILITY NUMBER:
585407983
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
09/14/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Ana SotoTIME COMPLETED:
02:15 PM
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On 9/14/2021 at 12:45pm, Licensing Program Analyst (LPA) Laura Chavez conducted a prelicensing inspection in response to an application for a change of location, the requested capacity is 8. During todays inspection LPA discussed and reviewed current and previous information regarding COVID-19 with the licensee. COVID related posters are posted as required. Days and hours of operation will be 7 days a week, 24 hours a day. The licensee understands that 24 hour care to one child at one time is not allowed. Two adults and one minor currently reside in the home. The licensee is the homeowner. A review of the Facility Personnel Report Summary made on 9/8/2021 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. During today’s inspection the home and grounds were toured. The home appears to be clean and orderly at this time and will remain so during child care hours. No children were observed left in any parked vehicle. Notification of Parents Rights, Emergency Disaster Plan, with the Earthquake Preparedness Checklist are posted. The residence is a five bedroom/three bath two story home. The second floor of the home and garage are off-limits to children. A gate has been placed at the bottom of the stairs making the second floor off-limits. The garage is made off-limits via a doorknob cover. There is a locked wooden cabinet in the garage making all poisons inaccessible to children. No cords to window blinds were observed. Electrical outlets not used are covered as required. required. There is a working telephone. The sharp knives, cleaning supplies, medicines, are stored out of the reach of children. The licensee reports there are no weapons in the home and none were observed 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, carbon monoxide detector and fire extinguisher rated at least 2A10BC.

Report Continued: See LIC 809-C
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Laura Chavez
LICENSING EVALUATOR SIGNATURE: DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/14/2021
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: SOTO, ANA FAMILY CHILD CARE HOME
FACILITY NUMBER: 585407983
VISIT DATE: 09/14/2021
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The licensee has current pediatric CPR and First Aid certification, which expire on 7/8/2023. The children will use the back yard as their outdoor play area and is fully fenced. A picket fence surrounds the heating and air conditioning unit to prevent children from accessing. There is no 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. The licensee stated that the trampoline located in the backyard came with the house and will not be used by children in care.

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 licensing the home:
1. Completed Mandated Reporter Training.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Laura Chavez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021
LIC809 (FAS) - (06/04)
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