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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 485408136
Report Date: 05/31/2022
Date Signed: 05/31/2022 02:19:17 PM

Document Has Been Signed on 05/31/2022 02:19 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:WHITE, CHARLOTTE FAMILY CHILD CARE HOMEFACILITY NUMBER:
485408136
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
05/31/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Charlotte WhiteTIME COMPLETED:
02:20 PM
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On 5/31/2022 at 1:45 PM, Licensing Program Analyst (LPA) J. Helton conducted a pre-licensing inspection in response to an application for a capacity of 8. Days and hours of operation will be Monday-Sunday; 6am-11pm. The applicant understands that 24 hour care shall not be provided to one child at any one time. The applicants CPR and First Aid expirer 6/23/2023. The home was toured inside and out. The residence is a five bedroom, 3 bath home. Two adults and three minors reside in the home. The home is clean and orderly at this time and will remain so during child care hours. The floor and yard plans submitted were verified. Gates have been installed to prevent children from accessing off-limit areas. No poisons in the home, detergents are locked upstairs with magnetic locks and stairs are blocked with baby gate.. Cords to window blinds were observed, Applicant has made the cords inaccessible by moving up and pinning cords to top of the window. There is a working telephone. Fire place not being used and is glass and screened. Switch is hidden from children's view. The applicant understands the a barrier shall be installed if the fireplace is used while children are in care. The sharp knives, cleaning supplies, medicines, are stored out of the reach of children, and in locking cabinets. There are age appropriate toys available for the children. There is a working smoke detector, carbon monoxide detector and several a fully charged fire extinguisher rated at least 2A10:BC in the home. Notification of Parents Rights, Emergency Disaster Plan, with the Earthquake Preparedness Checklist shall be posted. The applicant is aware that all adults residing or working at the facility must have a criminal background clearance on file with CCLD. The applicant understands that minors residing in the home must be fingerprinted within 30 days of reaching their 18th birthday and obtain a TB clearance. The applicant is aware of the immediate $100 per day civil penalty for adults working or residing in the home without a criminal record clearance. The applicant understands that if she does not carry liability insurance for the family child care home, parents will be required to sign insurance affidavits.
SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Jackie Helton
LICENSING EVALUATOR SIGNATURE: DATE: 05/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/31/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: WHITE, CHARLOTTE FAMILY CHILD CARE HOME
FACILITY NUMBER: 485408136
VISIT DATE: 05/31/2022
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The children will use the back yard as the outdoor play area, and it is fully fenced with a locking gate. There are no pools or bodies of water on the premises, and back yard has age appropriate toys for the children.

There firearms in the home.
LPA reviewed with applicant/licensee/facility representative 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.
LPA discussed the safe sleep regulations with applicant/licensee/facility representative 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/licensee/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.

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.

Exit interview conducted and report was reviewed with the applicant Charlotte White.
SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Jackie Helton
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2022
LIC809 (FAS) - (06/04)
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