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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525407993
Report Date: 02/09/2023
Date Signed: 03/14/2023 10:23:21 AM

Document Has Been Signed on 03/14/2023 10:23 AM - 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:RIVERA, ANGELICA FAMILY CHILD CARE HOMEFACILITY NUMBER:
525407993
ADMINISTRATOR:RIVERA, ANGELICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 875-0912
CITY:CORNINGSTATE: CAZIP CODE:
96021
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
02/09/2023
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Angelica RiveraTIME COMPLETED:
10:15 AM
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An informal meeting was conducted with licensee over phone. The meeting was attended by Licensing Program Manager, Megan Aviles and Licensing Program Analyst Bianca Mendez. The purpose for the meeting was to discuss the citation that was issued for the absence of supervision on 1/13/23. Licensee was cited for leaving children under the supervision of an underage minor.

The licensee described her plan of correction to hire an assistant over the age of 18 years old. Licensee stated that she will not leave her under age assistant alone with children and will be at the facility at all times. Licensee has hired an assistant for emergencies and LPM Aviles and LPA Mendez verified that the livescan for assistant is cleared as of 1/21/23. LPM Aviles explained that assistant needs to have the required immunizations and certified CPR/First Aid before being left alone with children.

Read and reviewed report with licensee

SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Bianca Mendez
LICENSING EVALUATOR SIGNATURE: DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/09/2023
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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