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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313611358
Report Date: 04/16/2024
Date Signed: 04/16/2024 03:20:38 PM

Document Has Been Signed on 04/16/2024 03:20 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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:PENA DE LICATA, ROSAFACILITY NUMBER:
313611358
ADMINISTRATOR/
DIRECTOR:		PEÑA DE LICATA, ROSAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 408-7838
CITY:LINCOLNSTATE: CAZIP CODE:
95648
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 22DATE:
04/16/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:15 PM
MET WITH:Paul LicataTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
NARRATIVE
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On Tuesday, April 16, 2024, Licensing Program Analsyts (LPAs) Lea Habtom and Matthew Gallo arrived at the family childcare home of Rosie Pena De Licata to open a complaint. A case management inspection was conducted based on observation after arriving at the home. LPAs observed 22 children being supervised by 3 assistants. Licensee was not present in the home and will not return until the following day. Licensee did not make licensing staff aware of her time away from the facility.

Based on today's inspection, Title 22 regulations were cited on 809-D.

This report was reviewed with assistant Paul Licata since licensee is not present to accept the report. A notice of site visit was provided to be posted for 30 days. Appeal rights provided.

LPA Lea Habtom informed assistant Paul Licata that this report dated 4/16/2024 documents 1 Type A citation 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. Also, LPA Lea Habtom informed the assistant to provide a copy of this licensing report dated 4/16/2024 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.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE: DATE: 04/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/16/2024
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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Document Has Been Signed on 04/16/2024 03:20 PM - It Cannot Be Edited


Created By: Lea Habtom On 04/16/2024 at 01:50 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: PENA DE LICATA, ROSA
FACILITY NUMBER: 313611358

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/17/2024
Section Cited
CCR
102416.5(a)

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Staffing Ratio & Capacity 102416.5(a): The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time. This requirement was not met as evidenced by observation during inspection that 22 children were present being supervised by 3 staff.
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Assistant states they will not be combining facilities and will not accept children once the capacity of 12 or 14 is reached. Return visit will be conducted to ensure compliance.
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This posses an immediate health and safety risk to the 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:Keven Peters
LICENSING EVALUATOR NAME:Lea Habtom
LICENSING EVALUATOR SIGNATURE:
DATE: 04/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/16/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/16/2024 03:20 PM - It Cannot Be Edited


Created By: Lea Habtom On 04/16/2024 at 02:46 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: PENA DE LICATA, ROSA
FACILITY NUMBER: 313611358

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/30/2024
Section Cited
CCR
102417(a)

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Operation of a Family Child Care Home 102417(a): Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day. This requirement was not as evidenced by observations and interviews that revealed
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Assistant states that facility will close at future dates when licensee is not present, including tomorrow while the licensee travels back to the home.
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licensee was absent from Monday- Wednesday which posses a potential risk to the 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:Keven Peters
LICENSING EVALUATOR NAME:Lea Habtom
LICENSING EVALUATOR SIGNATURE:
DATE: 04/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/16/2024


LIC809 (FAS) - (06/04)
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