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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483009866
Report Date: 11/14/2022
Date Signed: 11/14/2022 02:42:35 PM

Document Has Been Signed on 11/14/2022 02:42 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:AGUILAR, MIRANDA & AARON FCCHFACILITY NUMBER:
483009866
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 10DATE:
11/14/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Miranda Aguilar - LicenseeTIME COMPLETED:
03:00 PM
NARRATIVE
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During the course of a complaint investigation, Licensing Program Analyst (LPA), M. Augustin conducted an unannounced Case Management visit to deliver a citation to Licensee, Miranda Aguilar (LS). Upon LPA’s arrival to the facility at 12:15pm, LPA observed LS alone was supervising ten children in the backyard. LPA did not see any other staff present and LS stated she was the only staff present at the facility, and LS did not have another staff that was immediately available to assist with supervision of the children. Furthermore, LS stated she was operating in accordance with Provider Information Notice (PIN-04-CCP) that was released on 03/16/20 which allowed child to staff ratio to be no greater than 10:1 due to the COVID pandemic, however; PIN-04-CCP was retracted by the Department. LS conveyed three children would be picked up later in the day which would bring the total number of children to seven. LPA consulted on and provided LS with California Code of Regulations, 102416.5(a) of Staffing Ratio and Capacity, and LS stated she understood the requirements; and LS appeared to have acknowledged the requirements.

Exit interview conducted, and report was reviewed with the licensee, Miranda Aguilar. Appeal rights were provided. 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. LPA Melchisedeck Augustin informed licensee, Miranda Aguilar that this report dated 11/14/2022 document(s) 1 Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care. Also, LPA Melchisedeck Augustin informed the licensee to provide a copy of this licensing report dated 11/14/2022 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE: DATE: 11/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/14/2022
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 11/14/2022 02:42 PM - It Cannot Be Edited


Created By: Melchisedeck Augustin On 11/14/2022 at 01:26 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
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: AGUILAR, MIRANDA & AARON FCCH
FACILITY NUMBER: 483009866

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/15/2022
Section Cited
CCR
102416.5(a)

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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.

This requirement is not met as evidenced by: Based on LPA's observations at 12:15pm of LS alone supervising ten children in the backyard.
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Licensee stated she would ensure she had emergency staff to ensure adequate supervision of children and Licensee intends to submit an application to the Regional Office to apply for a capacity increase. The Licensee stated she would submit a written statement detailing on she intends to comply with CCR 102416.5(a), as well as LPA intends to conduct a
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This posed an immediate health, safety risk to the children in care.
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follow up visit to ensure compliance with capacity requirements. Licensee stated she would submit her POC to the Department by 11/15/22 via mail, email or fax.

Email: melchisedeck.augustin@dss.ca.gov
Fax: 707-588-5099

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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:Leslie Lepori
LICENSING EVALUATOR NAME:Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:
DATE: 11/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/14/2022


LIC809 (FAS) - (06/04)
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