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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 515408343
Report Date: 11/04/2024
Date Signed: 11/04/2024 01:59:40 PM

Document Has Been Signed on 11/04/2024 01:59 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 CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:CONTRERAS, JASMEENA FAMILY CHILD CARE HOMEFACILITY NUMBER:
515408343
ADMINISTRATOR/
DIRECTOR:		CONTRERAS, JASMEENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 682-4142
CITY:YUBA CITYSTATE: CAZIP CODE:
95993
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
11/04/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Jasmeena ContrerasTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
NARRATIVE
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On 11/04/24 at 1:00pm, an unannounced case management inspection was conducted by Licensing Program Analyst (LPA) Elizabeth Friese. The LPA met with licensee Jasmeena Contreras. When LPA Friese initially arrived at the home, an assistant (S1) was supervising 7 children and operating within ratio requirements. Licensee arrived approximately 5 minutes after LPA.
During the inspection one staff file (S1) was reviewed.

The following 2 Type B deficiencies were cited by file review: S1 had no mandated reporter and no immunizations on file.

Exit interview was conducted and report was reviewed with the licensee Jasmeena Contreras. Appeal rights were provided.

A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Elizabeth Friese
LICENSING EVALUATOR SIGNATURE: DATE: 11/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2024
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 11/04/2024 01:59 PM - It Cannot Be Edited


Created By: Elizabeth Friese On 11/04/2024 at 01:09 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: CONTRERAS, JASMEENA FAMILY CHILD CARE HOME
FACILITY NUMBER: 515408343

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/04/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/04/2024
Section Cited
HSC
1596.8662(b)(1)

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(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee.... shall complete the mandated reporter training ... and shall complete renewal mandated reporter training every two years...
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Licensee to provide proof of S1's mandated reporter training to CCLD by POC date
mandatedreporterca.com
elizabeth.friese@dss.ca.gov
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This requirement is not met as evidenced by:
Based on record review, the licensee did not comply with the section cited above in 2 counts of the Licensee and Assistant S1 not having current mandatated reporter training which poses/posed a potential health, safety or personal rights risk to persons in care.
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Type B
12/04/2024
Section Cited
HSC1597.7995(a)(1)

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Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles..employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
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Licensee to provide S1's immunizations and flu vaccine/declination to CCLD by POC date.
elizabeth.friese@dss.ca.gov
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This requirement is not met as evidenced by:
1 of 1 file's reviewed indicated S1 had no immunizations or flu shot/declination on file.
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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:Elizabeth Friese
LICENSING EVALUATOR SIGNATURE:
DATE: 11/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/04/2024


LIC809 (FAS) - (06/04)
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