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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 585406908
Report Date: 01/03/2024
Date Signed: 01/04/2024 10:46:24 AM

Document Has Been Signed on 01/04/2024 10:46 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:FERREYRA, LIDIA FAMILY CHILD CARE HOMEFACILITY NUMBER:
585406908
ADMINISTRATOR:FERREYRA, LIDIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 315-5095
CITY:MARYSVILLESTATE: CAZIP CODE:
95901
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
01/03/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Daniela FerreyraTIME COMPLETED:
01:20 PM
NARRATIVE
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On January 3, 2024, at 9:40am, Licensing Program Analyst (LPA) Laura Chavez conducted an unannounced case management inspection and met with Assistant Daniela Ferreyra (A1). The assistant was supervising 4 children. During today's inspection A1 admitted to providing care to children without completing CPR/First Aid, Mandated Reporter Training and not having proof of the required immunization's.

The following deficiencies were cited: 102416(c) -Personnel Requirements, HSC1596.8662(b)(1) and HSC 1507.622(a)(1), (see LIC 809D):

Appeal Rights and a Notice of Site Visit was given. The Notice of Site Visit must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.00. All licensing reports are public information and must be made available upon request for at least three years.

Exit interview conducted and report was reviewed with Daniela Ferreyra, Assistant.

SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Laura Chavez
LICENSING EVALUATOR SIGNATURE: DATE: 01/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/03/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
Document Has Been Signed on 01/04/2024 10:46 AM - It Cannot Be Edited


Created By: Laura Chavez On 01/03/2024 at 11:49 AM
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: FERREYRA, LIDIA FAMILY CHILD CARE HOME
FACILITY NUMBER: 585406908

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/05/2024
Section Cited
CCR
102416(c)

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Personnel Requirements: The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.
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The provider agrees to provide proof of current CPR/First Aid.

The plan of correction shall be submitted to CCLD on or before 2/5/2024
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This requirement is not met as evidenced by: A1's admission of not having current certification in CPR/First Aid.
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The plan of correction shall be submitted to CCLD on or before 2/5/2024
Type B
02/05/2024
Section Cited
HSC1596.8662(b)(1)

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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 (MRT) provided pursuant to paragraphs (2) and (3) subdivision (a) and shall
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The provider agrees to provide proof of current Mandated Reporter Training.

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complete renewal (MRT) every two years following the date on which he or she completed the initial MRT.

This requirement is not met as evidenced by: A1's admission of not completing the MRT as required.
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The plan of correction shall be submitted to CCLD on or before 2/5/2024
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: 01/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/03/2024


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 01/04/2024 10:46 AM - It Cannot Be Edited


Created By: Laura Chavez On 01/03/2024 at 12:08 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: FERREYRA, LIDIA FAMILY CHILD CARE HOME
FACILITY NUMBER: 585406908

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/05/2024
Section Cited
HSC
1597.622(a)(1)

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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.
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The provider agrees to provide proof of immunization's for A1 against influenza, pertussis, and measles.
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This requirement is not met as evidenced by: A1's admission of not having proof of immunization's against influenza, pertussis, and measles.
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The plan of correction shall be submitted to CCLD on or before 2/5/2024.

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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: 01/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/03/2024


LIC809 (FAS) - (06/04)
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