<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 065406112
Report Date: 10/24/2019
Date Signed: 10/31/2019 02:03:31 PM

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:CERVANTES, PATRICIA FAMILY CHILD CARE HOMEFACILITY NUMBER:
065406112
ADMINISTRATOR:CERVANTES, PATRICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 908-2043
CITY:WILLIAMSSTATE: CAZIP CODE:
95987
CAPACITY:14CENSUS: 8DATE:
10/24/2019
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Patricia CervantesTIME COMPLETED:
11:40 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
An annual random inspection was made to the facility by Licensing Program Analyst (LPA), Laura Chavez. A review of staff records on 10/16/201 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Currently 4 adults reside in the home. During today’s inspection the home and grounds were toured. The licensee and her assistant were supervising 8 children, and operating within the licensed capacity and ratio requirements. No children were observed left in any parked vehicle. The facility’s operating hours are 5:00am to 7:00pm, Monday–Friday. he floor plan submitted by the licensee was reviewed and verified. Currently there are no off-limit areas in the home. The home is clean, orderly and comfortable. There are safe toys and equipment available for children. The licensee stated there is a working telephone in the home. The licensee’s pediatric CPR and First Aid certifications were reviewed, and expire on 8/29/2021. Items which could pose a danger to children (such as detergents, cleaning compounds, medications, etc.) are stored out of the reach of children. Poisons are locked in a shed located in the backyard. The wood stove has been made inaccessible with a screen. The LPA observed a working smoke detector, carbon monoxide detector and fire extinguisher, rated at least 2A10BC, in the home. The licensee was unable to locate her roster of children in care and documentation of the last emergency drill conducted. The licensee stated there are no firearms and/or other dangerous weapons in the home and none were observed during today's inspection. The

Report Continued: See LIC 809-C
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura ChavezTELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2019
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 3
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: CERVANTES, PATRICIA FAMILY CHILD CARE HOME
FACILITY NUMBER: 065406112
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/24/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/23/2019
Section Cited

1
2
3
4
5
6
7
Operation of a Family Child Care Home (FCCH): Each FCCH shall conduct fire drills and disaster drills at least once every six months. The licensee shall document the drills, including the date and time of each drill. This documentation shall be kept at the family child care home.
8
9
10
11
12
13
14
This requirement was not met as evidenced by: the licensee unable to locate documentation of the last fire and disaster drill conducted with children in care.
8
9
10
11
12
13
14
Type B
11/23/2019
Section Cited

1
2
3
4
5
6
7
Immunization's: The licensee shall document each child's immunization's as required, and shall maintain such documentation for as long as the child is enrolled.
This requirement was not met as evidenced by: the licensee failing to obtain immunization records for Child #1, #2, an #3.
Type B
11/23/2019
Section Cited

1
2
3
4
5
6
7
Operation of a Family Child Care Home: Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This requirement was not met as evidenced by: the licensee unable to locate her current roster of children in care
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura ChavezTELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 10/24/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/24/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: CERVANTES, PATRICIA FAMILY CHILD CARE HOME
FACILITY NUMBER: 065406112
VISIT DATE: 10/24/2019
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
children use the backyard as the outdoor play area and it is fully fenced. The spa located in the backyard is locked as required. Ten children's records were reviewed at 10:25am; immunization records are missing for Child #1, #2 and #3. Notification of Parent’s Rights forms were on file. The licensee is not providing Incidental Medical Services (IMS) to children in care. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding the American Disabilities Act (ADA) was provided: US Department of Justice toll-free ADA Information Line at (800) 514-0301 (voice)/(800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, www.ada.gov/childqanda.htm. This report, as well as information regarding Safe Sleep Practices were reviewed and discussed with the licensee. 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.

The following violations of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Appeal Rights were provided.
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura ChavezTELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3