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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093622098
Report Date: 11/14/2024
Date Signed: 11/14/2024 02:34:34 PM

Document Has Been Signed on 11/14/2024 02:34 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:BAUTISTA, PERLAFACILITY NUMBER:
093622098
ADMINISTRATOR/
DIRECTOR:		BAUTISTA, PERLAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 721-7896
CITY:SOUTH LAKE TAHOESTATE: CAZIP CODE:
96151
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
11/14/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Perla BautistaTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
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On November 14, 2024, Licensing Program Analyst (LPA) Soleil Marx met with Licensee, Perla Bautista, for an unannounced annual inspection. During the inspection there was a census of ten children in care being supervised by the licensee and assistant. Ages of children were verified during file review to ensure ratio/capacity were adhered to. Facility hours of operating are 7 days a week from 8:30 AM-5:00 PM

All individuals subject to criminal background review have obtained a criminal record clearance. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

The off-limits areas include: 2 bedrooms, right side deck, and shed. Licensee understands that children may never enter off-limit areas. LPA observed the off-limit areas of the home were inaccessible by closed doors and supervision. A health and safety inspection was conducted in the areas accessible to children. LPA observed a working telephone, functioning smoke and carbon monoxide detector, and a fully charged 2A10BC fire extinguisher within the home. LPA observed home was sanitary, safe, and orderly. LPA observed that hazardous items: detergents, cleaning compounds, medication, sharp utensils, and other items that could pose a danger to children in care, are properly stored out of children's reach and/or in a child locked cabinet. Licensee understands that if there are any poisons in the home, all poisons must be locked with a key lock or combination lock. LPA observed a variety of age-appropriate toys, equipment, and materials available to children within the home. LPA observed fireplace within the home is barricaded to meet regulations; there are no stairs in the home. Licensee stated there are no firearms, or bodies of water on the premises.

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Soleil Marx
LICENSING EVALUATOR SIGNATURE: DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/14/2024
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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: BAUTISTA, PERLA
FACILITY NUMBER: 093622098
VISIT DATE: 11/14/2024
NARRATIVE
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LPA reviewed facility, licensee/assistant, and children's records. LPA observed all required postings were posted and visible to authorized representatives. LPA observed a complete children's roster maintained and a fire drill log with drills being conducted and documented at least every six months. LPA reviewed records of children’s files and verified all files contained the required licensing forms. LPA reviewed records of Licensee's and Assistant files. LPA could not verify current approved pediatric CPR/First Aid training or Mandated Reporter Training. Licensee understands both CPR and mandated reporter training's’ must be completed every two years. Licensee is aware of and practicing safe sleep requirements for infants in care.

LPA discussed the safe sleep regulations with licensee and the Child Care Licensing Safe Sleep webpage:https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleepLPA informed 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 PIN 22-02- CCP. 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 publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

During the exit interview, the licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. Based on today’s inspection, two type B deficiencies were cited. Exit interview conducted and report was reviewed with the licensee. A notice of site visit was given and must remain posted for 30 days. Appeal rights provided.

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Soleil Marx
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/14/2024 02:34 PM - It Cannot Be Edited


Created By: Soleil Marx On 11/14/2024 at 02:18 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: BAUTISTA, PERLA
FACILITY NUMBER: 093622098

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/14/2024

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 record review, the licensee did not comply with the section cited above by not having current Mandated Reporter Training which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/13/2024
Plan of Correction
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Licensee will complete Mandated Reporter Training and submit certification to LPA Marx by POC due date
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) 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.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above by not having approved current CPR certification which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/13/2024
Plan of Correction
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Licensee will complete approved CPR Training and submit certification to LPA Marx by POC due date
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:Natalie Dunaway
LICENSING EVALUATOR NAME:Soleil Marx
LICENSING EVALUATOR SIGNATURE:
DATE: 11/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/14/2024


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