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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 065406112
Report Date: 11/16/2023
Date Signed: 11/16/2023 11:34:36 AM


Document Has Been Signed on 11/16/2023 11:34 AM - 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: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:
11/16/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Patricia CervantesTIME COMPLETED:
10:15 AM
NARRATIVE
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On November 16, 2023 at 9:25am, Licensing Program Analyst (LPA) Laura Chavez conducted an unannounced case management inspection and met with licensee Patricia Cervantes. Upon arrival to the home LPA observed the licensee caring for six infants between the ages of 4 months and 1.6 years, and two toddlers between the ages of 2.7 years and 3.3 years old without an assistant present.

The following deficiency was cited: 102416.5-Staffing Ratio and Capacity (see LIC809D).



Appeal Rights and a Notice of Site Visit was given. The Notice of Site Visit must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.00. All licensing reports are public information and must be made available upon request for at least three years.

An exit interview was conducted and the report was reviewed with licensee Patricia Cervantes.
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura ChavezTELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/16/2023
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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Document Has Been Signed on 11/16/2023 11:34 AM - It Cannot Be Edited

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: 11/16/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/16/2023
Section Cited
CCR
102416.5(e)

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Staffing Ratio and Capacity: If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c).
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The licensee agrees to view the video provided on the Departments website
(https://ccld.childcarevideos.org) regarding staffing and ratios. Once viewed the licensee agrees to submit a written statement on how she will maintain staffing capacity ratios as required.
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Based on observation, the licensee did not comply with the section cited above. LPA observed the licensee caring for 8 children, 6 infants between the ages of 4 months and 1.6 years, and 2 toddlers between the ages of 2.7 years and 3.3 years old without an assistant present.
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Licensee also agrees to provide a copy of the children's attendance schedule to show how she will meet the requirements of the allowed infants in care at one time.
The Plan of Correction shall be submitted to CCLD on or before 12/15/2023.

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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: 11/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/16/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2