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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 293624312
Report Date: 05/01/2023
Date Signed: 05/01/2023 12:27:40 PM

Document Has Been Signed on 05/01/2023 12:27 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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:AGUILAR, JUANFACILITY NUMBER:
293624312
ADMINISTRATOR:AGUILAR, JUANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 414-6786
CITY:TRUCKEESTATE: CAZIP CODE:
96161
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 17DATE:
05/01/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Juan AguilarTIME COMPLETED:
12:35 PM
NARRATIVE
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At 10:25am on 5/1/2023, Licensing Program Analyst (LPA) Matthew Gallo met with Licensee Juan Aguilar for the purpose of conducting a plan of correction visit.

Upon arrival, LPA observed 17 children being supervised by 3 staff members. Licensee acknowledged that they were over their licensed capacity of 14 children and stated that they have parents selected to reduce the amount of children in care and that they are trying to expedite the process. LPA communicated the overriding importance of resolving this deficiency within 24 hours.

A Title 22 Deficiency is cited on the accompanying LIC809-D

Licensee acknowledges, that FOR TYPE A DEFICIENCIES ONLY upon receipt, licensee shall post LIC 809D with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the licensee. LIC 9224 and Appeal Rights were provided.

Exit interview conducted and report was reviewed with the licensee Juan Aguilar. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE: DATE: 05/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/01/2023
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 05/01/2023 12:27 PM - It Cannot Be Edited


Created By: Matthew Gallo On 05/01/2023 at 11:51 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
, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: AGUILAR, JUAN
FACILITY NUMBER: 293624312

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/02/2023
Section Cited
CCR
102416.5(f)

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(f) The total licensed capacity for a Large Family Child Care Home shall not exceed fourteen children.

This requirement is not as evidenced by:
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Licensee acknowledges that they cannot exceed the limits of their license and states that they have selected parents to reduce the amount of children in care. LPA Gallo will return to confirm licensee is within capacity guidelines.
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Based on observation and interview, the licensee did not comply with the section above by providing care to 17 children at one time, which poses an immediate health, safety or personal rights risk to persons in care.
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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:Keven Peters
LICENSING EVALUATOR NAME:Matthew Gallo
LICENSING EVALUATOR SIGNATURE:
DATE: 05/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/01/2023


LIC809 (FAS) - (06/04)
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