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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 515406330
Report Date: 09/03/2019
Date Signed: 09/04/2019 02:47:23 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:ALVARADO, MARIA FAMILY CHILD CARE HOMEFACILITY NUMBER:
515406330
ADMINISTRATOR:ALVARADO, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 673-2724
CITY:YUBA CITYSTATE: CAZIP CODE:
95993
CAPACITY:14CENSUS: 12DATE:
09/03/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
05:15 PM
MET WITH:Maria AlvaradoTIME COMPLETED:
06:05 PM
NARRATIVE
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LPA conducted a case management inspection to the home. During today's inspection required children's files for Child #6 and Child #14 were not made available for LPA's review.

All licensing reports are public information and must be made available upon request for at least three years.
Notice of Site Visit shall be posted for 30 days from today's visit.

The following Title 22 deficiency was cited during today's visit. See LIC 809-D.
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura ChavezTELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2019
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: ALVARADO, MARIA FAMILY CHILD CARE HOME
FACILITY NUMBER: 515406330
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/03/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/30/2019
Section Cited

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Child's Records: All children's records shall be available to the Department to inspect, audit, and copy upon demand during normal business hours.
This requirement was not met as evidenced by: Children's files for Child #6 and Child #14 were not available.

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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: 09/03/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/03/2019
LIC809 (FAS) - (06/04)
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