Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 535406471
Report Date: 09/30/2015
Date Signed 09/30/2015 11:25:52 AM

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:INGRAM, REBECCA FAMILY CHILD CARE HOMEFACILITY NUMBER:
535406471
ADMINISTRATOR:INGRAM, REBECCAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 680-9626
CITY:WEAVERVILLESTATE: CAZIP CODE:
96093
CAPACITY:14CENSUS: 6DATE:
09/30/2015
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Rebecca IngramTIME COMPLETED:
11:30 AM
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(3) A visit was made to the facility by LPA, Chris Archer. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. There are presently two adults living in the home.

During today’s visit the home and grounds were toured and the licensee was operating within the licensed capacity. Operating hours are 7:30am to 5:30pm, Mon–Fri. The floor plan was verified. Off limits areas (upstairs - gate, and the living room, front bedroom and front bathroom - gates) are inaccessible. There is a working telephone in the home. The fireplace is inaccessible in the living room. The staircase is barricaded. The licensee's pediatric CPR and First Aid expire 8/31/17. Items which could pose a danger to children (detergents, cleaning compounds, and medications) were stored out of the reach of children. Poisons are locked in the detached shop. There is a working smoke detector, carbon monoxide detector and fire extinguisher in the home. The licensee has a current roster of children in care and has conducted an emergency drill within the past six months. The licensee stated there are no firearms and/or other dangerous weapons in the home and none were observed during today's visit. The children use the backyard as the outdoor play area and it is completely fenced. Children's records were reviewed and in substantial compliance. The licensee is not providing Incidental Medical Services – IMS at this time. All licensing reports are public information and must be made available upon request for at least three years.
Notice of Site Visit shall be posted for 30 days from today's visit.

There were no Title 22 deficiencies cited during today's visit.

SUPERVISOR'S NAME: Lisa McKayTELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Christen ArcherTELEPHONE: (530) 895-4230
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2015
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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