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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 515408343
Report Date: 03/05/2025
Date Signed: 03/05/2025 11:58:18 AM

Document Has Been Signed on 03/05/2025 11:58 AM - 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: 3DATE:
03/05/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:Jasmeena ContrerasTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
NARRATIVE
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On 3/5/25 @ 10:45am , Licensing Program Analyst (LPA) Elizabeth Friese conducted a case management visit for uncleared POC's.

The following deficiency was cited: 1 Type B violation for: 2 of 4 children's files (C2, C3) missing immunizations. This violation was originally cited on 1/03/25 and corrections have not been received as of the writing of this report.

Exit interview conducted, report reviewed and appeal rights provided to Licensee Jasmeena Contreras.

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: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2025
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 03/05/2025 11:58 AM - It Cannot Be Edited


Created By: Elizabeth Friese On 03/05/2025 at 10:41 AM
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: 03/05/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/05/2025
Section Cited
CCR
102418(g)

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(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

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Licensee to submit immunizations for C2 and C3 to CCLD by POC date
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This requirement is not met .
as evidenced by:

Forms not submitted to CCLD by previous POC date of 2/05/25
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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: 03/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/05/2025


LIC809 (FAS) - (06/04)
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