343618034-10-12-2020-03-CC-TWAN-BUBLTQ-20201012090240

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343618034
Report Date: 10/08/2020
Date Signed: 10/12/2020 09:02:56 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME:	BILIK, FLORA		FACILITY NUMBER:	343618034
ADMINISTRATOR:	BILIK, FLORA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 247-3284
CITY:	ORANGEVALE	STATE: CA	ZIP CODE:	95662
CAPACITY:	14	CENSUS: 7	DATE:	10/08/2020
TYPE OF VISIT:	Case Management - Incident	ANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Flora Bilik		TIME COMPLETED:	12:30 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	Licensing Program Analyst Tanya Washington contacted Licensee Flora Bilik for an announced case management inspection regarding a self reported unusual incident. Due to COVID19 pandemic the visit is being conducted via Facetime. During the call, Licensee toured the facility, LPA observed 7 children supervised by Licensee and two staff. Licensee reported that on September 23, 2020 there was a child who wondered away from her facility. According to Licensee during the time of the incident her two staff were providing care to eleven children, also present in the home was the cook and Licensee's spouse who was watering the lawn in the front yard. The Licensee was not in the home when the incident occurred. Licensee reported that Child #1 asked Staff #1 to use the restroom, as Child #1 was in the restroom, Staff #1 asked Child #1 if they were finished, Child #1 was taking a while. During this time another child needed attention, Staff #1 walked away from the restroom. Child #1 exited the restroom and sneaked out through the front door. According to Licensee, Staff #1 returned to check on Child #1 realizing that they are not there. All staff started searching for Child #1 in the backyard as Child #1 was hiding in the playhouse earlier in the day and inside the home. Staff realized Child #1 wasn’t anywhere in the home, at this time Licensee returned and was immediately alerted that Child #1 was missing. Licensee got in her car and started driving around the neighborhood looking for Child #1, Licensee stated that her spouse Michael also started driving around in a separate vehicle looking for Child #1. Licensee located Child #1 approximately half a mile away from the facility. LPA Washington spoke to Child #1s parent who stated that the facility handled the situation quickly and professionally. Parent indicated that Child #1 was not used to being at day-care all day and was trying to get home because they missed them. Licensee indicated that Child #1 was without supervision for approximately 15 minutes. Continued on LIC809C

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya Washington	TELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2020

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: BILIK, FLORA	FACILITY NUMBER: 343618034
	VISIT DATE: 10/08/2020

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Licensee took immediate corrective measures to prevent the reoccurrence of such an incident by implementing the following: Licensee stated that she implemented a daily safety class for all children. She purchased additional security cameras and will ensure that when someone is at the door and the alarm goes off that her and staff will double check who is at the door.

Facility is being cited a Zero Tolerance violation for this incident. Civil Penalties are assessed in the amount of $500.00 for lack of supervision. Please refer to attached LIC809D for deficiency cited.

This is a Type A deficiency, hence AB633 Notification Applies: Upon receipt of this report, the report must be posted along with the notice of site visit for 30 days for parents to view. Licensee must inform the parents/guardians of children in care at the facility and to the parents/guardians of children newly enrolled at the facility during the next 12 months via form LIC 9224.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya Washington	TELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2020

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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: BILIK, FLORA	FACILITY NUMBER: 343618034
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/08/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Request Denied Type A 10/08/2020 Section Cited	1 2 3 4 5 6 7	The licensee shall be present in the home and shall ensure that children in care are supervised at all times. This requirement is not met as evidenced: Licensee self reported that Child #1 wondered away from
	8 9 10 11 12 13 14	her facility. Child #1 was safely located approximately 15 minutes later. This is a zero tolerance violation and a civil penalty in the amount of $500.00 dollars is being assessed.	8 9 10 11 12 13 14	Licensee will ensure that when the door alarm goes off she herself or staff will double check who is at the door. Licensee does not agree with being cited for self reporting and will be appealing.
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	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) 263-5744
LICENSING EVALUATOR NAME: Tanya Washington	TELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2020

LIC809 (FAS) - (06/04)

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