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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 515407040
Report Date: 10/21/2022
Date Signed: 10/21/2022 01:35:10 PM

Document Has Been Signed on 10/21/2022 01:35 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
CHICO-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:CARTER, TIANA FAMILY CHILD CARE HOMEFACILITY NUMBER:
515407040
ADMINISTRATOR:CARTER, TIANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 718-8402
CITY:YUBA CITYSTATE: CAZIP CODE:
95991
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
10/21/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Tiana CarterTIME COMPLETED:
01:35 PM
NARRATIVE
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Licensing Program Analyst (LPA) J. Helton conducted an unannounced case management visit to inform licensee that she is has failed to pay her civil penalties. Failure to pay by (11/4/2022 will results in a Non-compliance conference and/or forfeiture of license.

Licensee stated she understands and will pay the remaining balance within the next 2 weeks.

The following deficiencies were cited 1596.803(e) The failure of an applicant for licensure or a licensee to pay all applicable and accrued fees and civil penalties shall constitute grounds for denial or forfeiture of a license. (see LIC 809D):


Exit interview conducted and report was reviewed with the licensee Tiana Carter.

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: Erin Virrueta
LICENSING EVALUATOR NAME: Jackie Helton
LICENSING EVALUATOR SIGNATURE: DATE: 10/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/21/2022
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 10/21/2022 01:35 PM - It Cannot Be Edited


Created By: Jackie Helton On 10/21/2022 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
, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: CARTER, TIANA FAMILY CHILD CARE HOME
FACILITY NUMBER: 515407040

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/21/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/04/2022
Section Cited
HSC
1596.803(e)

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1596.803(e) The failure of an applicant for licensure or a licensee to pay all applicable and accrued fees and civil penalties shall constitute grounds for denial or forfeiture of a license
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Licensee states will pay full amount or set up a payment plan and will provide verification to LPA.
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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:Erin Virrueta
LICENSING EVALUATOR NAME:Jackie Helton
LICENSING EVALUATOR SIGNATURE:
DATE: 10/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/21/2022


LIC809 (FAS) - (06/04)
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