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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 553615674
Report Date: 08/12/2024
Date Signed: 08/12/2024 01:25:25 PM


Document Has Been Signed on 08/12/2024 01:25 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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:BALANCO, EMILYFACILITY NUMBER:
553615674
ADMINISTRATOR:LOPEZ, EMILYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 559-3948
CITY:SONORASTATE: CAZIP CODE:
95370
CAPACITY:14CENSUS: 4DATE:
08/12/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Licensee, Emily BalancoTIME COMPLETED:
01:40 PM
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On 08/12/2024, Licensing Program Analyst Tobias Lake and Licensing Program Manager Bettina Engelman arrived at the facility to conduct an unannounced Plan of Correction (POC) inspection to verify corrections of deficiencies cited on 08/1/2024.

On that date, facility was cited for one Type A citation for uncleared adult, and Type B citations for; Not being present for at least 80% of day care hours during the day, children's documentation, requirement for staff to have completed mandated reporter training, and making alterations prior to informing the Department.
During today's inspection, LPA toured the on-limits area of the home and observed 4 children in care and one staff and licensee present.

The Type B citation for children's documentation, as of 08/12/24 this citation is cleared.

For the Type A deficiency for an uncleared adult, the plan of correction due 08/05/2024 was not completed as of 8/12/2024. While licensee submitted a statement saying she understands the requirement, the uncleared adult is still not cleared, and continues to reside in the facility. Licensee stated that the individual is not present during daycare hours. Licensing staff did not observe the uncleared adult today. Civil penalties will be assessed for the failure to correct this deficiency today.

For the Type B deficiency regarding requirement to be present at least 80% of day care hours daily, Plan of Correction was due 08/02/2024. Licensee did not return to the facility until 08/11/2024, civil penalties will be assessed.
For Type B deficiency regarding requirement to undergo mandated reporter training, plan of correction was due 08/09/24. As of 08/12/2024, plan of correction has not been met. Civil penalties will be assessed.
For Type B related to modification of garage without notifying the Department, plan of correction is no longer requested due to Licensee choosing to forfeit their license and close the facility on 8/24/2024.

No additional deficiency was cited today. An exit interview was conducted with Licensee Balanco. Appeal rights were provided and explained. A notice of Site Visit was posted by the LPA and must remain posted for 30 days.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Tobias LakeTELEPHONE: 916-224-9388
LICENSING EVALUATOR SIGNATURE:
DATE: 08/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/12/2024
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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