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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 515405268
Report Date: 08/03/2023
Date Signed: 08/04/2023 04:27:00 PM

Document Has Been Signed on 08/04/2023 04:27 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:SAUCEDO, MELBA FAMILY CHILD CARE HOMEFACILITY NUMBER:
515405268
ADMINISTRATOR:SAUCEDO, MELBAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 671-3108
CITY:YUBA CITYSTATE: CAZIP CODE:
95993
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
08/03/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Melba SaucedoTIME COMPLETED:
01:15 PM
NARRATIVE
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On 8/3/2023 at 11:20am, Licensing Program Analyst (LPA) Laura Chavez conducted a case management inspection in response to an incident that occurred on 7/24/2023 involving Child #1 inappropriately touching Child #2 while both children sat next to each other on the sectional sofa. The licensee self-reported the incident on the day of the incident.

Licensee stated the incident occurred during nap time at approximately 2:30pm-2:35pm. Licensee said four of the six children in care at the time of the incident had fallen asleep. Licensee said she laid back on the right side of the sectional sofa while Child #1 and Child #2 sat on opposite sides of the cup holders located on the left side of the sectional sofa as they watched a movie on the TV. Child #1 got up, plugged the phone into an outlet, returned to the sofa, and sat on the same cushion next to Child #2. Licensee said seconds after Child #1 sat down she observed Child #1 inappropriately touching Child #2. Licensee said she immediately separated Child #1 and Child #2 and notified the parents of the two children of the incident. The licensee immediately terminated the care of Child #1 on the day of the incident. An interview conducted on 8/3/2023 at 11:38am with Child #2 determined that the licensee’s eyes were closed and may have been asleep at the time of the incident.

LPA Laura Chavez informed Licensee Melba Saucedo that this report dated 8/3/2023 documents one 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.

Report continued: See LIC 809-C

SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Laura Chavez
LICENSING EVALUATOR SIGNATURE: DATE: 08/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/03/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: SAUCEDO, MELBA FAMILY CHILD CARE HOME
FACILITY NUMBER: 515405268
VISIT DATE: 08/03/2023
NARRATIVE
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Also, LPA Laura Chavez informed the licensee to provide a copy of this licensing report dated 8/3/2023 that documents any Type A citation 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.

Appeal rights were provided, an exit interview was conducted, and the report was reviewed with Licensee Melba Saucedo. A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Laura Chavez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/04/2023 04:27 PM - It Cannot Be Edited


Created By: Laura Chavez On 08/03/2023 at 12:36 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
, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: SAUCEDO, MELBA FAMILY CHILD CARE HOME
FACILITY NUMBER: 515405268

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/04/2023
Section Cited
CCR
102417(a)

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Operation of a Family Child Care Home: The licensee shall be present in the home and shall ensure that children in care are supervised at all times.


This requirement is not met as evidenced by:
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The licensee agrees to view the video provided by the Department through
(https://ccld.childcarevideos.org/) titled Supervising Children in Family Child Care.
Licensee also agrees to provide a written statement on how she will ensure children in care are supervised at all times.
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A lack of supervision resulted in Child #1 inappropriately touching Child #2.
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The plan of correction shall be submitted to CCLD on or before 8/4/2023.

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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:Megan Aviles
LICENSING EVALUATOR NAME:Laura Chavez
LICENSING EVALUATOR SIGNATURE:
DATE: 08/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/03/2023


LIC809 (FAS) - (06/04)
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