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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343621823
Report Date: 11/03/2023
Date Signed: 11/03/2023 01:38:54 PM

Document Has Been Signed on 11/03/2023 01:38 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:VALENCIA, EMILIAFACILITY NUMBER:
343621823
ADMINISTRATOR:VALENCIA, EMILIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 648-1661
CITY:SACRAMENTOSTATE: CAZIP CODE:
95833
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
11/03/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Emilia ValenciaTIME COMPLETED:
02:00 PM
NARRATIVE
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On November 3, 2023 Licensing Program Analyst (LPA) Lea Habtom conducted an inspection to open a complaint. LPA L. Habtom met with licensee, Emilia Valencia. At the time of arrival there was a census of 3 infants being supervised by licensee and her assistant, daughter. Licensee's spouse was also present in the home at the time of the inspection. LPA L. Habtom observed an infant in a baby walker and an infant also utilizing a saucer chair during the inspection. The licensee removed the infant from the walker and into the saucer. The licensee then removed the infant from the saucer and removed the items from the living room area. LPA L. Habtom notified licensee that two items are prohibited items in day care homes. Licensee removed both the saucer and baby walker and placed them into the garage, an off limits area. Licensee states she will remove the two items from the home.

Title 22 deficiency was cited at the time of inspection on 809-D.

Upon receipt of this report, the Licensee shall post the Notice of Site Visit and any Licensing report documenting a type “A” deficiency. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement of Receipt (LIC 9224 form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the Acknowledgement of Receipt of Licensing Reports (LIC 9224) Form during this visit.

A notice of site visit provided to posted for 30 days. Appeal rights provided.

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE: DATE: 11/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/03/2023
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 11/03/2023 01:38 PM - It Cannot Be Edited


Created By: Lea Habtom On 11/03/2023 at 01:17 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: VALENCIA, EMILIA
FACILITY NUMBER: 343621823

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/06/2023
Section Cited
CCR
102417(g)(10)

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102417(g)(10) Operation of a Family Child Care Home: A baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety Code Section 1596.846(b) and (c).

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Licensee placed items in an off limits area- garage & stated she would dispose of items.
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This requirement was not met as evidenced by:

LPA obeserved an infant (C1) using both a baby walker and a saucer chair during the inspection.
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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: 11/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/03/2023


LIC809 (FAS) - (06/04)
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