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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 293624312
Report Date: 11/15/2023
Date Signed: 11/15/2023 12:54:35 PM

Document Has Been Signed on 11/15/2023 12:54 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:AGUILAR, JUANFACILITY NUMBER:
293624312
ADMINISTRATOR:AGUILAR, JUANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 414-6786
CITY:TRUCKEESTATE: CAZIP CODE:
96161
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
11/15/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Juan AguilarTIME COMPLETED:
01:00 PM
NARRATIVE
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At 10:50am, Licensing Program Analyst (LPA) Matthew Gallo met with licensee Juan Aguilar for the purpose of opening a complaint investigation.

Upon entering facility at 10:50am, LPA observed a total census of 12 children. During file review and interview, LPA determined that 6 of the present children were infants under the age of 24 months.

A Type A citation is cited on the following 809-D for not adhering to 102416.5(d)(1) of Title 22 regulations, which limits the maximum amount of infants present at one time in a Large Family Daycare Home to 4. A review of facility compliance history revealed that a previous deficiency for the same regulation was cited on 4/20/2023. Due to that date falling within the previous 12 months of today's deficiency, a civil penalty of $250 will be assessed for a repeat violation, accruing $100 per day until the deficiency is corrected.

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. Appeal rights and LIC9224 provided.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2023
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 11/15/2023 12:54 PM - It Cannot Be Edited


Created By: Matthew Gallo On 11/15/2023 at 12:13 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: AGUILAR, JUAN
FACILITY NUMBER: 293624312

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/16/2023
Section Cited
CCR
102416.5(d)(1)

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(d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home...shall be either: (1) Twelve children, no more than four of whom may be infants; or
This requirement is not met as evidenced by:
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Licensee acknowledges that they must abide by their licensed capacity limit of no more than 4 infants at one time, and will have parents sign a written statement acknowledging that licensee is required to turn away any further infants the moment they already have 4 in care. Licensee will send LPA proof of signed copies by POC due date.
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Based on observation, interivew, and record review, LPA determined that six infants were present at the facility. This poses an immediate health, safety, or personal rights risk to persons in care.
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CCR

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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: 11/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/15/2023


LIC809 (FAS) - (06/04)
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