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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 515404057
Report Date: 10/16/2020
Date Signed: 03/30/2023 09:14:18 PM

Document Has Been Signed on 03/30/2023 09:14 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:AVALOS, MARIA FAMILY CHILD CARE HOMEFACILITY NUMBER:
515404057
ADMINISTRATOR:AVALOS, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 671-4117
CITY:YUBA CITYSTATE: CAZIP CODE:
95991
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
10/16/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Maria AvalosTIME COMPLETED:
03:00 PM
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On 10/16/2020 at 1:45pm, Licensing Program Analyst (LPA) Laura Chavez conducted a Case Management tele-inspection with licensee Maria Avalos. The inspection was conducted via FaceTime due to the current State of Emergency caused by COVID-19. The tele-inspection is in response to an Unusual Incident Report received involving injury to a child on 10/14/2020. According to the report, Child #1 was scratched on the left cheek and bit under the left arm by the licensee's grandson's Chihuahua dog. The bite broke the skin, but did not require the child to be taken in for medical attention. The licensee said she immediately applied first aid to the child and contacted the child's guardian. The licensee stated she did not witness the incident, she had stepped out of the house to throw a soiled diaper into the trash can located outside when it occurred. Three children were in care at the time of the incident. During the tele-visit, LPA interviewed Child #1, #2 and #3. During the inspection, LPA observed the Chihuahua inside the main house, area which is off-limits to children.

Due to insufficient information at this time, the above requires further investigation. This report was reviewed and discussed with the licensee. All licensing reports are public information and must be made available upon request for at least three years.

There were no Title 22 deficiencies cited during today's inspection.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Laura Chavez
LICENSING EVALUATOR SIGNATURE: DATE: 10/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/16/2020
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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