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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 293624312
Report Date: 05/09/2023
Date Signed: 05/09/2023 02:14:23 PM

Document Has Been Signed on 05/09/2023 02:14 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: DATE:
05/09/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Juan AguilarTIME COMPLETED:
02:30 PM
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
At 1:00pm on 5/9/2023, Licensing Program Analysts (LPAs) Matthew Gallo and Lea Habtom met with Licensee Juan Aguilar for the purpose of conducting a plan of correction visit.

Upon arrival, LPA observed 3 staff members supervising 12 children, composed of 4 infants and 8 preschool children. In the course of taking census, LPAs observed an infant sleeping in a play yard with a pacifier clip attached to their sleep sack. A separate infant was observed sleeping with a blanket in their play yard. A further infant was observed sleeping with a stuffed animal in their play yard. Each case observed by LPAs represents a violation of Safe Sleep regulations.

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.

Licensee corrected deficiencies on-site while LPAs were present.

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: 05/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2023
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
Document Has Been Signed on 05/09/2023 02:14 PM - It Cannot Be Edited


Created By: Matthew Gallo On 05/09/2023 at 01:38 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
, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: AGUILAR, JUAN
FACILITY NUMBER: 293624312

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/09/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/10/2023
Section Cited
CCR
102425(b)(1)

1
2
3
4
5
6
7
Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee will remove all objects from play yards with sleeping infants and acknowledges that play yards or cribs must be free of loose objects per Safe Sleep regulations
8
9
10
11
12
13
14
Based on observation, the licensee did not comply with the section above in 3 out of 4 cases in which play yards containing sleeping infants contained, respectively, a blanket, a stuffed animal, and a pacifier with a clip attached to their sleep sack in their play yard.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: 05/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/09/2023


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