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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 515404776
Report Date: 08/01/2019
Date Signed: 08/02/2019 10:42:04 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/25/2019 and conducted by Evaluator Laura Chavez
PUBLIC
COMPLAINT CONTROL NUMBER: 13-CC-20190725160905
FACILITY NAME:CHAVEZ, MARIA FAMILY CHILD CARE HOMEFACILITY NUMBER:
515404776
ADMINISTRATOR:CHAVEZ, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 755-9830
CITY:YUBA CITYSTATE: CAZIP CODE:
95993
CAPACITY:14CENSUS: 8DATE:
08/01/2019
UNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Maria ChavezTIME COMPLETED:
03:10 PM
ALLEGATION(S):
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Operating over capacity
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Laura Chavez conducted an unannounced complaint inspection and met with licensee Maria Chavez. It was alleged that the facility was operating over capacity. The licensee denied the allegation and stated she may have indicated incorrect times on the attendance sheet of children in care. A review of the licensee's May 2019 Attendance Sheets indicates the licensee was caring for 16 children on May 15, 2019 between 1:45pm - 2:06pm.

Based on interviews conducted and available information obtained, the preponderance of evidence standard has been met, therefore, the allegation is substantiated. An exit interview was conducted with the licensee, a plan of correction was discussed and appeal rights were provided.

Notice of Site Visit shall be posted for 30 days from today's visit.

The following violation of the California Code of Regulations, Title 22; Division 12, was cited: see LIC 9099D.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura ChavezTELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2019
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 13-CC-20190725160905
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: CHAVEZ, MARIA FAMILY CHILD CARE HOME
FACILITY NUMBER: 515404776
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/01/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/31/2019
Section Cited
CCR
102416(5)(a)
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Staffing Ratio and Capacity. The capacity specified on the license shall be the maximum number of children for whom care can be provided.

This requirement was not met as evidenced by: A review of the licensee's Attendance
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The licensee agrees to provide a written statement on how she will ensure adhering to the capacity specified on the license.

The written statement shall be submitted to CCLD on or before 8/31/2019.
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Sheets for May 2019 indicating a capacity of 16 children between 1:45pm - 2:06pm.
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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: 08/01/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2019
LIC9099 (FAS) - (06/04)
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