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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 515406344
Report Date: 10/25/2022
Date Signed: 11/10/2022 12:46:44 PM

Document Has Been Signed on 11/10/2022 12:46 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:AGUILAR, EVANGELINA FAMILY CHILD CARE HOMEFACILITY NUMBER:
515406344
ADMINISTRATOR:AGUILAR, EVANGELINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 632-0339
CITY:YUBA CITYSTATE: CAZIP CODE:
95993
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
10/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Evangelina AguilarTIME COMPLETED:
04:10 PM
NARRATIVE
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On 10/25/2022 at 11:25am, a Required -1 Year inspection was made to the facility by Licensing Program Analyst (LPA), Laura Chavez. At 11:50am the home was toured inside and outside. The licensee and two assistants were supervising 10 children and operating within the licensed capacity and ratio requirements.The facility’s operating hours are 4:30am-7:00pm, Monday–Saturday, Sunday's as needed. A review of the Facility Personnel Report Summary dated 10/7/2022 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances. The floor plan and yard sketch submitted by the licensee were reviewed and verified. The off-limits areas of the home are the garage, laundry room, downstairs bedroom and the second story of the home, these areas were made inaccessible by gates and doorknob covers. The children use the backyard as the outdoor play area and it is fully fenced. There is an in-ground pool in the backyard. The pool area is fenced in with a 6' solid concrete block wall. The pool is covered with a Pool Safety Net. LPA observed the licensee walk across the pool to show that the cover supports the weight of an adult.

Items that could pose a danger to children (such as detergents, cleaning compounds, etc.) are stored out of the reach of children. Poisons are located in an enclosed cupboard located in the garage. The LPA observed a working smoke detector, carbon monoxide detector, and fire extinguisher, rated at least 2A10BC, in the home.

The licensee did not have a current roster of children in care. The licensee stated that she has not conducted an emergency drill within the past six months.

Report continued: See LIC 809-C's
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Laura Chavez
LICENSING EVALUATOR SIGNATURE: DATE: 10/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/25/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: AGUILAR, EVANGELINA FAMILY CHILD CARE HOME
FACILITY NUMBER: 515406344
VISIT DATE: 10/25/2022
NARRATIVE
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Nine children's records were reviewed at 12:50pm. In the process of reviewing the children's records LPA found that immunization records were not available for Child #1, 3, 7 and 9. Three staff records were reviewed at 11:40am. In the process of reviewing staff records LPA found that the licensee and Assistant #1 (A1) and #2 (A2) have not completed the Mandated Reporter Training as required. TB test results, required immunization's, completed and signed Criminal Record Statement, Employee Rights, and Acknowledgement of Suspected Child Abuse were not available for A1 and A2.

There are currently two adults living in the home. The Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with the licensee and discussed the Child Care Licensing Safe Sleep web page at:https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-
resources/safe-sleep as an additional resource. LPA also informed the licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to the publication: Commonly Asked Questions about Child Care and the ADA, available at: http://www.ada.gov/childqanda.htm

The following deficiencies were cited: see LIC 809D's:

Report continued: See LIC809-C

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

DATE: 10/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022
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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: AGUILAR, EVANGELINA FAMILY CHILD CARE HOME
FACILITY NUMBER: 515406344
VISIT DATE: 10/25/2022
NARRATIVE
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An exit interview was conducted, and the report was reviewed with Licensee Evangelina Aguilar.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Notice of Site Visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Laura Chavez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022
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Document Has Been Signed on 11/10/2022 12:46 PM - It Cannot Be Edited


Created By: Laura Chavez On 10/25/2022 at 03:15 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: AGUILAR, EVANGELINA FAMILY CHILD CARE HOME
FACILITY NUMBER: 515406344

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/25/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(4)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. (A) Storage areas for poisons, firearms and other dangerous weapons shall be locked.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on LPA's observation, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. Licensee neglected to lock the cabinet contaiining oisons located in the garage
POC Due Date: 10/28/2022
Plan of Correction
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2
3
4
The licensee agrees to provide proof of all poisons in the home being locked as required. Proof of correction shall be submitted to CCLD on or before 10/28/2022.
Type B
Section Cited
CCR
102417(g)(9)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on LPA's interview, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. The licensee failed to conduct a fire and disaster drill within the last 6 months.
POC Due Date: 11/25/2022
Plan of Correction
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2
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The licensee agrees to provide proof of having conducted an emergency disaster drill as required. Proof of correction shall be submitted to CCLD on or before 11/25/2022.
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: 10/25/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/25/2022


LIC809 (FAS) - (06/04)
Page: 4 of 9
Document Has Been Signed on 11/10/2022 12:46 PM - It Cannot Be Edited


Created By: Laura Chavez On 10/25/2022 at 03:15 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: AGUILAR, EVANGELINA FAMILY CHILD CARE HOME
FACILITY NUMBER: 515406344

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/25/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on staff record reviews, the licensee did not comply with the section cited above. The licensee and A1 and A2 have not completed the required mandated reporter training as required which poses a potential health, safety or personal rights risk to persons in care. The licensee failed to renew the mandated reporter training as required.
POC Due Date: 11/25/2022
Plan of Correction
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The licensee agrees to provide proof of she, A1 and A2 completing the required mandated reporter trainings. Proof of correction shall be submitted to CCLD on or before 11/25/2022.
Type B
Section Cited
HSC
1596.8662(c)
Administration of Child Day Care Licensing
(c) Current proof of completion for each licensed child day care provider or applicant for that license, administrator, and employee of a licensed child day care facility shall be submitted to the department upon inspection of the child day care or upon request by the department.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on staff record review, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/25/2022
Plan of Correction
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The licensee agrees to provide proof of she, A1 and A2 completing the required mandated reporter trainings. Proof of correction shall be submitted to CCLD on or before 11/25/2022.
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: 10/25/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/25/2022


LIC809 (FAS) - (06/04)
Page: 5 of 9
Document Has Been Signed on 11/10/2022 12:46 PM - It Cannot Be Edited


Created By: Laura Chavez On 10/25/2022 at 03:15 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: AGUILAR, EVANGELINA FAMILY CHILD CARE HOME
FACILITY NUMBER: 515406344

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/25/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on children's records review, the licensee did not comply with the section cited above in three out of nine file reviews which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/25/2022
Plan of Correction
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2
3
4
The licensee agrees to provide proof of current immunization records for Child #1, 3, 7 and 9. Proof of correction shall be submitted to CCLD on or before 11/25/2022.
Type B
Section Cited
CCR
102416.1(a)(10)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information: (10) A signed and dated copy of the Notice of Employee Rights [LIC 9052, (Rev. 03/03)] as required by Section 102416(a) and Section 102417.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on staff record reviews, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/25/2022
Plan of Correction
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2
3
4
The licensee agrees to provide copies of signed Employee Rights for A1 and A2. Proof of correction shall be submitted to CCLD on or before 11/25/2022.
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: 10/25/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/25/2022


LIC809 (FAS) - (06/04)
Page: 6 of 9
Document Has Been Signed on 11/10/2022 12:46 PM - It Cannot Be Edited


Created By: Laura Chavez On 10/25/2022 at 03:15 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: AGUILAR, EVANGELINA FAMILY CHILD CARE HOME
FACILITY NUMBER: 515406344

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/25/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.1(a)(11)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information: (11) A signed statement regarding their criminal record history as required by Section 102370(c).

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on staff record reviews, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/25/2022
Plan of Correction
1
2
3
4
The licensee agrees to provide copies of completed Criminal Record Statements for A1 and A2. Proof of correction shall be submitted to CCLD on or before 11/25/2022.
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on staff record reviews, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/25/2022
Plan of Correction
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2
3
4
The licensee agrees to provide proof of required immunizations for A1 and A2. Proof of correction shall be submitted to CCLD on or before 11/25/2022.
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: 10/25/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/25/2022


LIC809 (FAS) - (06/04)
Page: 7 of 9
Document Has Been Signed on 11/10/2022 12:46 PM - It Cannot Be Edited


Created By: Laura Chavez On 10/25/2022 at 03:15 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: AGUILAR, EVANGELINA FAMILY CHILD CARE HOME
FACILITY NUMBER: 515406344

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/25/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(a)
Immunizations
(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on children record reviews, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/25/2022
Plan of Correction
1
2
3
4
The licensee agrees to submit a written statement on how she will ensure proof of immunizations for children prior to admitting them into care. The plan of correction shall be submitted to CCLD on or before 11/25/2022.
Type B
Section Cited
CCR
102417(g)(8)
Operation of A Family Child Care Home
(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA's interview with the licensee, the licensee did not comply with the sectin cited above which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/25/2022
Plan of Correction
1
2
3
4
The licensee agrees to provide a current roster of children in care. The plan of correction shall be submitted to CCLD on or before 11/25/2022.
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: 10/25/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/25/2022


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