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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 515405620
Report Date: 03/13/2020
Date Signed: 03/13/2020 01:45:20 PM

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:HARROLD, BRUCEANN FAMILY CHILD CARE HOMEFACILITY NUMBER:
515405620
ADMINISTRATOR:HARROLD, BRUCEANNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 740-3797
CITY:YUBA CITYSTATE: CAZIP CODE:
95991
CAPACITY:14CENSUS: 12DATE:
03/13/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Brueann HarroldTIME COMPLETED:
01:50 PM
NARRATIVE
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On 1/28/20 Licensing Program Analyst (LPA) Martinez and Grisak conducted an annual inspection to the home of the licensee Burceann Harrold. At the end of the visit we were advised by the Licensee she wanted to make me aware of a possible abuse situation. When questioned by the LPA's when she initially heard this information she stated in December. I, LPA Martinez questioned why it took her so long to report the information and the licensee stated she wanted to wait till her yearly visit. LPA's advised the provider to turn in the SCAR or Incident report by the end of day regarding the information she was aware of. As of 1/30/20, LPA Martinez had not received any documentation regarding the suspected abuse and had called and emailed the provider to request the document be submitted. At that time the provider emailed LPA back with less information than was stated during the initial annual visit. On 1/31/20 LPA Martinez received the SCAR report and submitted to appropriate local agencies.

It should be noted during the Annual inspection at the facility on 1/28/20 Mandated Reporter training was current for the licensee and assistants working in the home. The procedures for reporting suspected abuse was discussed with the licensee by LPA Martinez and Grisak on 1/28/20. Based on the information above,
The following violation(s) of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Appeal Rights were provided.
SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Mikah MartinezTELEPHONE: (530) 895-4014
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2020
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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: HARROLD, BRUCEANN FAMILY CHILD CARE HOME
FACILITY NUMBER: 515405620
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/13/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/20/2020
Section Cited

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(b)(1) A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of a family day care home of any of the following events (C) Any unusual incident or child absence that threatens the
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physical or emotional health or safety of any child.
This requirement was not met as evidenced by; Based on interviews the licensee was made aware of suspected abuse sometime in December of 2019 and did not report to the department until 1/28/20. This is potential health and safety risk to children 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: Erin VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Mikah MartinezTELEPHONE: (530) 895-4014
LICENSING EVALUATOR SIGNATURE:
DATE: 03/13/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/13/2020
LIC809 (FAS) - (06/04)
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