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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 515408343
Report Date: 01/03/2025
Date Signed: 01/03/2025 01:11:13 PM

Document Has Been Signed on 01/03/2025 01:11 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: 4DATE:
01/03/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Jasmeena ContrerasTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
NARRATIVE
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On 1/03/25 at 12:30pm, an unannounced case management inspection was conducted by Licensing Program Analyst (LPA) Elizabeth Friese. The LPA met with licensee Jasmeena Contreras. A child’s injury requiring medical attention had occurred several weeks prior, which licensee did not report to the Department. It was also determined that a previously obtained roster was determined to be incomplete, specifically the parent/guardian column for each child was blank.

The following 2 Type B deficiencies were cited: 102416.2(b)(1), (failure to report), and 102417(g)(8), (current roster).

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: 01/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/03/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 01/03/2025 01:11 PM - It Cannot Be Edited


Created By: Elizabeth Friese On 01/03/2025 at 12:24 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: 01/03/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/03/2025
Section Cited
CCR
102416.2(b)(1)

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Reporting Requirements
(b) The licensee shall report to the Department any of the events as specified... (1) Medical treatment means treatment by a medical professional
This requirement was not met as evidenced by:
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Licensee will review and provide attestation of understanding of FCCH reporting requirements to CCLD by 2/03/24.
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Based on interview, the licensee did not comply with the section cited above in 1 instance, which poses/posed a potential health, safety or personal rights risk to children in care.

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Type B
02/03/2025
Section Cited
CCR102417(g)(8)

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Operation of a Family Child Care Home
(g) The home shall be free from... conditions which might endanger a child...
(8) Each family child care home shall have a current roster of children....
This requirement was not met as evidenced by:
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Licensee to provide a complete roster to CCLD by 2/03/24.
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Based on record review, the licensee did not comply with the section cited above in 1 instance, which poses/posed a potential health, safety or personal rights risk to children in care.
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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: 01/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/03/2025


LIC809 (FAS) - (06/04)
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