Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343618282
Report Date: 11/21/2019
Date Signed: 11/21/2019 09:59:31 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:MARIN, MARIA ELENAFACILITY NUMBER:
343618282
ADMINISTRATOR:MARIN, MARIA ELENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 834-1492
CITY:SACRAMENTOSTATE: CAZIP CODE:
95829
CAPACITY:14CENSUS: 0DATE:
11/21/2019
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Maria MarinTIME COMPLETED:
10:00 AM
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Licensing Program Manager (LPM) Roxana Saravia and Licensing Program Analyst (LPA) Mai Lor met with Licensee Maria Marin for an office informal meeting. LPM Saravia defined the difference between a non-compliance conference and an informal meeting. LPM advised that the purpose of today's meeting is to help Licensee gain compliance.

Today's informal meeting is to discuss a self-reported unusual incident that was received in the Sacramento Regional Office on 11/04/19 regarding a young child engaged in an inappropriate activity that was sexual in nature with another young, and the citations issued on 11/08/19 and 11/13/2019. The facility was cited for three Type A citations regarding care and supervision, stairs were not barricaded or gated when children under the age of five were present, and facility staff did not follow manufacture’s guidelines of the trampoline and did not ensure that safety precautions were taken when children were observed on the trampoline. Two Type B citations were also cited for children in off-limit areas and dog feces were observed throughout the backyard.

LPM and LPA discussed with licensee the importance of maintaining care and supervision of all children at all times. LPA and LPM also reiterated the importance of submitting plan of corrections by the due date. LPM advised licensee that compliance and understanding of all Title 22 regulations are licensee's responsibility and should ensure that staff is trained in accordance.

(Report continues on subsequent LIC 809)
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Mai LorTELEPHONE: (916) 491-0182
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2019
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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: MARIN, MARIA ELENA
FACILITY NUMBER: 343618282
VISIT DATE: 11/21/2019
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Licensee has taken the following steps to maintain compliance:

1. Licensee acknowledges that stairs shall always be barricaded when children under the age of five are present during day care hours. Licensee had replaced the current baby gate with a new baby gate for convenient.
2. Licensee acknowledges that care and supervision shall always be maintained.
Licensee had submitted a supervision plan and will follow the supervision plan.
3. Licensee acknowledges that she will follow manufacture’s guidelines of the trampoline and will take safety precaution when children are using the trampoline.
4. Licensee acknowledges that all plan of corrections shall be submitted by the due date.
5. Licensee acknowledges children are not allowed in off-limit areas. Off-limit area was changed from off-limit to on-limit.
6. Licensee acknowledges the home shall be kept clean and orderly. Licensee had cleaned up the dog feces.

LPM informed licensee that continued deficiencies in this area may result in further action, including a non-compliance meeting with the Regional Manager.

LPM provided a self-evaluation guide and suggested that licensee review the Department's website www.ccld.ca.gov for updated regulations and important information regarding licensing. LPM suggested that Licensee view informational videos at www.ccld.childcarevideos.org.

Exit interview conducted and a copy of this report was provided to the Licensees.

SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Mai LorTELEPHONE: (916) 491-0182
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2019
LIC809 (FAS) - (06/04)
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