065407293-8-8-2022-13-CC-LCHZ-CH4TM3-20220808145028

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 065407293
Report Date: 08/08/2022
Date Signed: 08/08/2022 02:50:48 PM

Document Has Been Signed on 08/08/2022 02:50 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:	BUGARIN, MARIA FAMILY CHILD CARE HOME		FACILITY NUMBER:	065407293
ADMINISTRATOR:	BUGARIN, MARIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(530) 473-5859
CITY:	WILLIAMS	STATE: CA	ZIP CODE:	95987
CAPACITY:	14	CENSUS: 8	DATE:	08/08/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	Maria Bugarin		TIME COMPLETED:	02:55 PM

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	On 8/8/2022 at 12:20pm, a Required -1 Year inspection was made to the facility by Licensing Program Analyst (LPA), Laura Chavez. At 12:30pm the home was toured inside and outside. The licensee was supervising 8 children and operating within the licensed capacity and ratio requirements. The facility operates 24 hours a day, 7 days a week. The licensee understands that 24 hour care to one child at one time is not allowed. A review of the Facility Personnel Report Summary dated 7/5/2022 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances. The floor plan and yard sketch submitted by the licensee were reviewed and verified. The off-limits areas of the home are the garage, three bedrooms, master bathroom, laundry room and garage, and were made inaccessible by [baby gates and locks. The children use the backyard as the outdoor play area and it it fully fenced. Upon entry to the home the licensee informed LPA Chavez that an above pool was installed in the backyard. The licensee failed to notify the Department prior to installing the pool. The pool is fully fenced with 6' dog ear fence boards and 6' cattle fencing. The pool is approximately 1/4 full with water. The licensee stated that she is in the process of taking down the pool and currently in the process of draining it. Items that 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 the garage. The LPA observed a working smoke detector, carbon monoxide detector, and fire extinguisher, rated at least 2A10BC, in the home. The roster of children in care was reviewed and was current. The licensee conducted an emergency drill within the past six months, the last drill was documented on 5/13/2022. Eight (8) children's records were reviewed at 1:05pm. One staff records were reviewed at 2:15pm. Report continued: See LIC 809-C's

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura Chavez	TELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2022

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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Document Has Been Signed on 08/08/2022 02:50 PM - 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: BUGARIN, MARIA FAMILY CHILD CARE HOME	FACILITY NUMBER: 065407293
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/08/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416.3(a)(3)

Alterations to Existing Buildings or Grounds This requirement is not met as evidenced by: The licensee's failure to notify the Department prior to installing an above ground pool.
	Deficient Practice Statement
1 2 3 4	Based on an interview, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/07/2022
	Plan of Correction
1 2 3 4	The licensee agrees to submit a written statement to CCLD on or before 9/7/2022 on how she will ensure notifying the Department prior to making any alterations to the existing buildings or grounds.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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 Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura Chavez	TELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2022

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: BUGARIN, MARIA FAMILY CHILD CARE HOME	FACILITY NUMBER: 065407293
	VISIT DATE: 08/08/2022

NARRATIVE

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There are currently four adults living in the home. The Licensee was reminded that all adults 18 and over living or working in the home, 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 Licensee Maria Bugarin and discussed the Child Care Licensing Safe Sleep web page at:https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-
sleep as an additional resource. LPA also informed the 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.

Incidental Medical Services (IMS) policy was discussed. 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 ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

The following deficiency was cited: 102416.3(a)(3) - Alterations to Existing Buildings or Grounds, see LIC 809-D.

An exit interview was conducted, and the report was reviewed with Licensee Maria Bugarin.

Report continued.

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura Chavez	TELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2022

LIC809 (FAS) - (06/04)

Page: 3 of 9

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: BUGARIN, MARIA FAMILY CHILD CARE HOME	FACILITY NUMBER: 065407293
	VISIT DATE: 08/08/2022

NARRATIVE

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To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at: www.cdss.ca.gov/inforesources/community-care-licensing/process.

Notice of Site Visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura Chavez	TELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2022

LIC809 (FAS) - (06/04)

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