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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 515406344
Report Date: 08/23/2022
Date Signed: 08/23/2022 02:06:31 PM


Document Has Been Signed on 08/23/2022 02:06 PM - It Cannot Be Edited

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:AGUILAR, EVANGELINA FAMILY CHILD CARE HOMEFACILITY NUMBER:
515406344
ADMINISTRATOR:AGUILAR, EVANGELINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 632-0339
CITY:YUBA CITYSTATE: CAZIP CODE:
95993
CAPACITY:14CENSUS: 11DATE:
08/23/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Evangelina AguilarTIME COMPLETED:
02:15 PM
NARRATIVE
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On 8/23/22 at 10:40am, Licensing Program Analyst's (LPA's), Laura Chavez and Bianca Mendez conducted a case management inspection to the home and met with Licensee Evangelina Mendez. During today's inspection LPA's observed an in-ground pool in the backyard. The pool is surrounded on three sides by a solid block wall and on one end is a wooden/wrought iron fence at the entry into the driveway. The block wall is 4' 3/4" tall with a 1' wrought iron railing at the top. A window from the play area and sliding glass door from the master bedroom lead into the pool area. The licensee stated that the pool was installed approximately one year ago. Licensee Aguilar failed to notify the Department prior to installing the pool. The licensee understands that the backyard will be remain off-limits to children until a plan has been approved.

During todays visit the licensee and four assistants (A1, A2, A3 and A4) were providing care and supervision to 11 children. At 10:34am LPA Chavez toured the home. LPA Chavez requested names of from each assistant providing care to children and found that the licensee failed to obtain a criminal record clearance for A1 prior to allowing A1 to work at the facility.

LPA's informed licensee Evangelina that this report dated 8/23/2022 documents two Type A citations which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.


Report continued: See LIC809-C
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura ChavezTELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2022
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 4


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: AGUILAR, EVANGELINA FAMILY CHILD CARE HOME
FACILITY NUMBER: 515406344
VISIT DATE: 08/23/2022
NARRATIVE
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Also, LPA's Chavez and Mendez informed the licensee to provide a copy of this licensing report dated 8/23/2022 that documents any Type A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

An exit interview was conducted and report was reviewed with Licensee Evangelina Aguilar.

During today's inspection Civil Penalties were assessed.

Notice of Site Visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura ChavezTELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 08/23/2022 02:06 PM - It Cannot Be Edited

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: AGUILAR, EVANGELINA FAMILY CHILD CARE HOME
FACILITY NUMBER: 515406344

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/23/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/24/2022
Section Cited

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Operation of a Family Child Care Home: All licensees shall ensure the inaccessibility of pools through a pool cover or by surrounding the pool with a fence. Fences shall be at least five feet high and shall be constructed so that the fence does not obscure the pool from view.
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This requirement was not met as evidenced by:
The licensee installed a solid block wall around the pool which obscures the pool from view. A window from the play area and a sliding glass door from the bedroom lead diectly into the pool area.
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Type A
08/24/2022
Section Cited

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Criminal Record Clearance: All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility obtain a California clearance or a criminal record exemption as required by the Department.
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This requirement was not met as evidenced by: The licensee failing to obtain a clearance on A1 prior to working at the facility.
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The plan of correction shall be submitted to CCLD on or before 8/24/2022.
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: 08/23/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4


Document Has Been Signed on 08/23/2022 02:06 PM - It Cannot Be Edited

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: AGUILAR, EVANGELINA FAMILY CHILD CARE HOME
FACILITY NUMBER: 515406344

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/23/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/23/2022
Section Cited

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Alterations to Existing Buildings or Grounds Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed change(s), including, but not limited to installation of in-ground or above-
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ground swimming pools, spas, fish ponds, decorative water feature, fountains or other bodies of water.This requirement was not met as evidenced by: The licensee failing to notify the Department prior to installing an in-ground pool.
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The plan of correction shall be submitted to CCLD on or before 9/23/2022.

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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: 08/23/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4