<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 115408276
Report Date: 09/04/2024
Date Signed: 09/04/2024 09:24:16 AM

Document Has Been Signed on 09/04/2024 09:24 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
CHICO CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:SARMENTO, CASSANDRA FAMILY CHILD CARE HOMEFACILITY NUMBER:
115408276
ADMINISTRATOR/
DIRECTOR:		SARMENTO, CASSANDRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 514-6136
CITY:ORLANDSTATE: CAZIP CODE:
95963
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
09/04/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:24 AM
MET WITH:Cassandra SarmentoTIME VISIT/
INSPECTION COMPLETED:
09:35 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 9/4/24 at 8:24am an unannounced case management inspection was conducted today by Licensing Program Analyst (LPA), Tammy Dutra. LPA met with Licensee Cassandra Sarmento in response to an Unusual Incident Report received by the Department on 8/23/24 where a child (C1) who was playing on the trampoline landed on their arm and broke it. C1 was jumping on the trampoline and landed on their right arm. C1 was acting injured and taken to receive medical care. C1 was taken to the hospital and it was established that C1 had a broken arm.

It was reported on 8/23/24 @ 1:45 pm child in care (C1) was outside playing on the trampoline, and fell on their left arm which resulted in two bones breaking. Licensee and assistant stated they was supervising three children and licensee was at the opening of the trampoline trying to zip up the net when the accident occurred.

On 9/4/24 Licensee and Assistant were interviewed and stated they were present for the accident. Assistant stated they were with two children in the yard when C1 was injured. Staff did not believe anything could have been done to prevent the accident.
SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Tammy Dutra
LICENSING EVALUATOR SIGNATURE: DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/04/2024
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: SARMENTO, CASSANDRA FAMILY CHILD CARE HOME
FACILITY NUMBER: 115408276
VISIT DATE: 09/04/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
On 8/29/24 C1's parent was interviewed and stated the accident was immediately reported and they did not feel the incident could have been prevented. Parent stated immediately after the accident the child wanted to play on the trampoline again. C1's parent stated they have no safety concerns for the child in licensee's care.

On 9/4/24 C1 was interviewed and described the incident exactly as it was reported to the department. C1 stated they jumped high and landed on their arm resulting in a broken arm. C1 confirmed Licensee was present at the opening of the trampoline at the time of the accident.

LPA confirmed trampoline was being used per manufacturers instructions and child was under constant supervision.

During today’s inspection, the facility was toured LPA observed 3 children in care.

There were no deficiencies cited during today’s inspection. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee Cassandra Sarmento.
SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Tammy Dutra
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2