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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343617989
Report Date: 03/04/2024
Date Signed: 03/04/2024 02:45:59 PM

Document Has Been Signed on 03/04/2024 02:45 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:NAVARRETTE, LORRAINEFACILITY NUMBER:
343617989
ADMINISTRATOR:NAVARRETTE, LORRAINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 613-3044
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
03/04/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Lorraine NavarretteTIME COMPLETED:
03:00 PM
NARRATIVE
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On 3/4/2024, Licensing Program Analyst (LPA) Michelle Perez, met with Lorraine Navarrette for the purpose of a complaint visit at approximately 12:35PM.
Upon arrival LPA observed 9 children, with the assistant. Licensee was not present within the home, as the licensee stated that there was an emergency that had to be tended to.


Licensee arrived back to the facility within 10 minutes after arrival. LPA explained that with a large family childcare the assistant cannot be left alone with more than 8 children. A small family childcare ratio must be adhered to.

Today's visit resulted in one type A deficiency.

Licensee will have all current guardians fill out the LIC 9224 (acknowledging the type A) and place it in each child's file. All new and incoming guardians, will also be required to fill out the LIC 9224 from today 3/4/2024 through 3/4/2025. Failure to place the LIC 9224 in each child's file, will result in a subsequent citation.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Michelle Perez
LICENSING EVALUATOR SIGNATURE: DATE: 03/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/04/2024
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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Document Has Been Signed on 03/04/2024 02:45 PM - It Cannot Be Edited


Created By: Michelle Perez On 03/04/2024 at 01:00 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: NAVARRETTE, LORRAINE
FACILITY NUMBER: 343617989

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/04/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/05/2024
Section Cited
CCR
102416.5(a)(e)

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The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time. If no assistant provider is present at a Large Family Child Care Home..
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Licensee arrived back to the facility while LPA was still present.
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 then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c)

This was not evidence by LPA observing only the assistant with 9 children.
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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:Michelle Perez
LICENSING EVALUATOR SIGNATURE:
DATE: 03/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/04/2024


LIC809 (FAS) - (06/04)
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