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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045408064
Report Date: 04/15/2022
Date Signed: 04/15/2022 01:40:33 PM

Document Has Been Signed on 04/15/2022 01:40 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:APPLEGATE, TRACIE FAMILY CHILD CARE HOMEFACILITY NUMBER:
045408064
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
04/15/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:55 AM
MET WITH:Tracie ApplegateTIME COMPLETED:
01:50 PM
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A prelicensing inspection was conducted today at 11:55am by Licensing Program Analyst (LPA), Emilia Grisak. LPA met with applicant Tracie Applegate. The applicant is requesting a license for a capacity of 8. The facility will operate Monday-Friday, 6:30am to 5:30pm. The residence is a three bedroom/three bath single story home. There are two adults and three minors currently living in the home.
The home and yard were toured, and the facility sketch was verified. The following areas will be off limits to children: kitchen, office, living room, three bedrooms, two bathrooms and outdoor deck. These areas have been made inaccessible by means of baby gates and door locks. There are also locks and alarms on all sliding glass doors leading to porch. Poisons are locked in locked cupboard in the dining room. The home is equipped with a working smoke detector and fire extinguisher. Fire extinguisher was not rated at least 2A10BC and applicant stated that she will obtain appropriate fire extinguisher and submit proof to LPA. The fireplace is securely screened with a baby gate. The children will have access to front yard and back yard but will primarily use the backyard as the outdoor play area. The backyard and front yard are not completely fenced, therefore, the applicant understands that constant supervision must be provided while children are outside. There is an above ground pool on the property which is fenced with chain link. Self-closing, self-latching device will be moved on gate and fence will be extended to the ground.
LPA reviewed with applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Home, children’s forms/records, facility forms/records, and information to be posted.
SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Emilia Grisak
LICENSING EVALUATOR SIGNATURE: DATE: 04/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/15/2022
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: APPLEGATE, TRACIE FAMILY CHILD CARE HOME
FACILITY NUMBER: 045408064
VISIT DATE: 04/15/2022
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Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed applicant 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.
Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.
To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.
The following items need to be completed prior to the granting of license:
1. Proof of fire extinguisher rated at least 2A10BC
2. Pool fencing modifications
Exit interview conducted and report was reviewed with the applicant Tracie Applegate.
SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Emilia Grisak
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2022
LIC809 (FAS) - (06/04)
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