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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343620805
Report Date: 05/30/2023
Date Signed: 05/30/2023 11:06:00 AM

Document Has Been Signed on 05/30/2023 11:06 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
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:AGUILERA, MARIAFACILITY NUMBER:
343620805
ADMINISTRATOR:MARIA AGUILERAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 308-9084
CITY:GALTSTATE: CAZIP CODE:
95632
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
05/30/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Licensee Maria AguileraTIME COMPLETED:
11:30 AM
NARRATIVE
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On 5/30/23, Licensing Program Analyst (LPA) Carla Polanco met with Licensee Maria Aguilera to follow up on an Unusual Incident Report (UIR) submitted to Community Care Licensing on 5/22/23. During today's visit the facility was toured. Present were 5 children being supervised by Licensee and one qualified assistant.

Per Licensee she had been completely absent from the facility as of May 14, 2023 due to an emergency, and returned on Sunday May 28, 2023. Licensee states that during her absence, she left her assistant Jessica Vazquez in charge of the daycare operations.

LPA informed Licensee Maria Aguilera, that this report dated May 30, 2023, documents a Type A citation, which is an immediate Health and Safety, or Personal Rights risk to persons in care. A separate 809-D page was issued for the deficiency.

An exit interview was conducted, and the report was reviewed with Licensee. LPA posted a notice of site visit. Licensee understands the notice must remain posted for 30 days and that a failure to comply with posting requirements shall result in an immediate civil penalty of $100. Appeal Rights were provided.
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Carla Polanco Rivera
LICENSING EVALUATOR SIGNATURE: DATE: 05/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/30/2023
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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Document Has Been Signed on 05/30/2023 11:06 AM - It Cannot Be Edited


Created By: Carla Polanco Rivera On 05/30/2023 at 10:27 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: AGUILERA, MARIA
FACILITY NUMBER: 343620805

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/30/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/01/2023
Section Cited
CCR
102417(a)

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The licensee shall be present in the home ...... children in care are supervised at all times. When... temporarily absent from the home... his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day. This requirement was not met by evidenced by:
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Licensee Maria Aguilera states that she will add her assistant Jessica Vazquez as a co-licensee. Licensee states that in the case she is absent from the daycare, Jessica Vazquez will take on the responsabilities of the daycare operations.
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Upon interview with Licensee Maria Aguilera, it was revealed that Licensee was not present in the home from May 14, 2023 through May 28, 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:Jeanne Smith
LICENSING EVALUATOR NAME:Carla Polanco Rivera
LICENSING EVALUATOR SIGNATURE:
DATE: 05/30/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/30/2023


LIC809 (FAS) - (06/04)
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