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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343618282
Report Date: 11/13/2019
Date Signed: 11/13/2019 03:32:48 PM

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:MARIN, MARIA ELENAFACILITY NUMBER:
343618282
ADMINISTRATOR:MARIN, MARIA ELENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 834-1492
CITY:SACRAMENTOSTATE: CAZIP CODE:
95829
CAPACITY:14CENSUS: 9DATE:
11/13/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Maria Marin TIME COMPLETED:
03:50 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Mai Lor and Christopher Bello conducted an unannounced case management inspection at the above facility and met with Licensee Maria. The purpose of this inspection is to follow-up on an unusual incident report received in the Sacramento Regional Office on 11/04/2019 regarding a young child engaging in an inappropriate activity that was sexual in nature with another young child. Interviews were conducted with some day care children, Licensee and Licensee’s adult daughter who is acting as her assistant. Interviews revealed that the facility staff did not provide adequate supervision when the day care children are using the bathroom. Licensee and her assistant stated they were unaware of the incident until information was provided by the parent. This poses an immediate health and safety risk to persons in care.

During this inspection, LPAs also conducted a plan of correction inspection for previous citations cited on 11/08/2019. LPAs observed the stairs barricaded and obtained written statements from Licensee and assistant acknowledging that they will follow trampoline manufacture’s guidelines. Licensee requested to put the backyard to on-limit. Licensee acknowledged and agreed to remove the play structure that is broken and when children are present in the backyard, children are to be supervised at all times. No children shall be on the play structure at any time.

During LPAs Lor and Bello inspection on 11/08/2019, LPAs observed multiple children in the backyard which is an off-limit area. LPAs also observed dog feces throughout the backyard. This poses a potential health and safety risk to persons in care.

See subsequent LIC 809 for deficiencies cited.

Exit interview conducted. Licensee acknowledges, that FOR TYPE A DEFICIENCIES ONLY upon receipt, licensee shall post LIC 809D with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the licensee. LIC 9224 and Appeal Rights were provided.

SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Mai LorTELEPHONE: (916) 491-0182
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2019
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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: MARIN, MARIA ELENA
FACILITY NUMBER: 343618282
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/13/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/14/2019
Section Cited

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The licensee shall be present in the home and shall ensure that children in care are supervised at all times…This requirement was not met as evidenced by: Based on interviews, the facility staff did not provide
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adequate supervision resulting in two day care children engaging in inappropriate sexual activity while in care. This poses an immediate health and safety risk to persons in care.
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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: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Mai LorTELEPHONE: (916) 491-0182
LICENSING EVALUATOR SIGNATURE:
DATE: 11/13/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/13/2019
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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: MARIN, MARIA ELENA
FACILITY NUMBER: 343618282
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/13/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/27/2019
Section Cited

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Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care. Based on observation, LPAs observed
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multiple children in the backyard which is an off-limit area on 11/08/19. This poses a potential health and safety to persons in care.
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Type B
11/18/2019
Section Cited

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The home shall be kept clean and orderly, with heating and ventilation for safety and comfort. Based on observations, LPAs observed dog feces throughout the backyard.
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This poses a potential health and safety risk to persons in care.

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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: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Mai LorTELEPHONE: (916) 491-0182
LICENSING EVALUATOR SIGNATURE:
DATE: 11/13/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/13/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3