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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 515404057
Report Date: 11/03/2020
Date Signed: 03/30/2023 09:34:57 PM

Document Has Been Signed on 03/30/2023 09:34 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: DATE:
11/03/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Maria AvalosTIME COMPLETED:
03:00 PM
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On 11/3/2020 at 2:40pm, 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. Today's inspection is a follow-up to the tele-inspection made on 10/16/2020 regarding the 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 immediately applied first aid to the child and contacted the child's guardian. The licensee stated she did not witness the dog injure the child, she had stepped out of the house to throw a soiled diaper into the trash can located outside when the incident occurred. Three children were in care at the time of the incident. During the tele-visit made on 10/16/2020, LPA interviewed Child #1, #2 and #3. Child #1 stated he was on the floor laying on his back when the dog ran up to him, scratching his left cheek and biting him under his left arm. Child #1 denied provoking the dog to cause the dog to injure him. Child #2 stated he crouched down, barked at the dog and ran away from him right before Child #1 was injured. Child #3 stated he was watching TV when he saw the dog scratch and bite Child#1. Child #2 and #3 stated they do not know what lead the dog to injure Child #1. On 10/17/2020, LPA re-interviewed Child #1 and #2 via telephone. Child #1 and #2 corroborated the information they provided on 10/16/2020. During today's inspection, LPA observed the Chihuahua inside the main house, area which is off-limits to children. Even though the dog does not have a history of biting and this may have been an isolated incident, the dog has bitten a child and therefore must be separated from the children in care. The licensee reported the incident to Community Care Licensing as required. 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: 11/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/03/2020
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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