093622098-2-2-2023-03-CC-NDUY-CP4S5J-20230216123425

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 093622098
Report Date: 02/02/2023
Date Signed: 02/02/2023 01:47:03 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/13/2023 and conducted by Evaluator Arianna Manabat

COMPLAINT CONTROL NUMBER: 03-CC-20230113121309

FACILITY NAME:	BAUTISTA, PERLA		FACILITY NUMBER:	093622098
ADMINISTRATOR:	BAUTISTA, PERLA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(530) 721-7896
CITY:	SOUTH LAKE TAHOE	STATE: CA	ZIP CODE:	96151
CAPACITY:	14	CENSUS: 12	DATE:	02/02/2023
		UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Perla Bautista		TIME COMPLETED:	02:10 PM

ALLEGATION(S):

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Licensee was operating over capacity

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Soleil Marx and Arianna Manabat met with Licensee Perla Bautista for the purpose of a complaint inspecion to deliver findings. It was alleged that the Licensee was operating over capactiy.

During the investigation, LPAs Marx and McClain observed attendance logs/time sheets that show that the Licensee was over capactiy by at least one child on nine occassions during the month of December 2022. The attendance logs/time sheets that were reviewed contained full legal signatures from both the Licensee and parents which indicated that the documentation was accurate.

Continued on LIC9099-C...

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Arianna Manabat	TELEPHONE: (279) 200-2886
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 03-CC-20230113121309

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: BAUTISTA, PERLA	FACILITY NUMBER: 093622098
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/02/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 02/03/2023 Section Cited CCR 102416.5(f)	1 2 3 4 5 6 7	102416.5 Staffing Ratio and Capacity (f) The total licensed capacity for a Large Family Child Care Home shall not exceed fourteen children. This regulation was not met as evidenced by:	1 2 3 4 5 6 7	Licensee stated that she will provide LPA Marx with schedule of chidlren in care, indicating that the facility is operating within ratio and capacity. LPAs have also documented that Licensee has been in compliance on both the 02/02/2023 visit and 01/19/2023.
	8 9 10 11 12 13 14	Based on interviews and record review, Licensee did not meet this requirement as facility records indicate that they operated above capacity on several occasions in December 2022, which poses an immediate health, safety or personal rights risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Arianna Manabat	TELEPHONE: (279) 200-2886
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 03-CC-20230113121309

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: BAUTISTA, PERLA	FACILITY NUMBER: 093622098
	VISIT DATE: 02/02/2023

NARRATIVE

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Based on Today’s inspection, Title 22 Deficiencies are being cited on 809-D. The Licensee was informed that this report dated 02/02/2023 documents one Type A citation which shall be posted for 30 consecutive days. The Licensee shall also provide a copy of this licensing report to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. Licensee has been provided with appeal rights.

A 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: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Arianna Manabat	TELEPHONE: (279) 200-2886
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

LIC9099 (FAS) - (06/04)

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