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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525407711
Report Date: 07/09/2024
Date Signed: 07/09/2024 09:19:18 AM

Document Has Been Signed on 07/09/2024 09:19 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:ALCALA, CHARITY FAMILY CHILD CARE HOMEFACILITY NUMBER:
525407711
ADMINISTRATOR/
DIRECTOR:		ALCALA, CHARITYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 526-2412
CITY:RED BLUFFSTATE: CAZIP CODE:
96080
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
07/09/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:25 AM
MET WITH:Charity Alcala - Licensee TIME VISIT/
INSPECTION COMPLETED:
09:30 AM
NARRATIVE
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An unannounced case management inspection was conducted today at 8:25am by Licensing Program Sydney Sims and Kayla Danielson. In response to an Unusual Incident Report received by the Department on June 27th 2024, where child C1 slipped from C2's grasped while transitioning off of a trampoline and sustained a mild concussion.

The licensee was interviewed on 6/27/24 at 10:04am and stated that on 6/26/24 at 7:40am child C1 was placed on the trampoline by child C2. Licensee witnessed C2 place C1 on the trampoline and asked C2 to remove C1. C2 attempted to remove C1 and during the transition C1 fell and sustained a mild concussion. Licensee stated that Day care children are not allowed to be on the trampoline and that there is no safety net installed.

One of parent was interviewed on 7/8/24 and stated that C1 did obtain a concussion from falling off the trampoline and that there was not a safety net around the trampoline at the time.

During today’s inspection, the facility was toured and there was six children in care. LPA observed that the trampoline has been taken down and is no longer at the facility.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Sydney Sims
LICENSING EVALUATOR SIGNATURE: DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/09/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: ALCALA, CHARITY FAMILY CHILD CARE HOME
FACILITY NUMBER: 525407711
VISIT DATE: 07/09/2024
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Based on information reported and interviews conducted the trampoline was being used to manufacture guidleines.the following deficiency is being cited on the LIC809-D. 102423(a)(2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.

LPA Sims and Danielson informed licensee Charity Alcala that this report dated 7/9/24 documents One Type A citation(s) which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

LPA Sims and Danielson informed the licensee to provide a copy of this licensing report dated 7/9/24 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.



Exit interview conducted and report was reviewed with the licensee Charity Alcala. Appeal Rights were provided.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Sydney Sims
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/09/2024 09:19 AM - It Cannot Be Edited


Created By: Sydney Sims On 07/09/2024 at 08:53 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: ALCALA, CHARITY FAMILY CHILD CARE HOME
FACILITY NUMBER: 525407711

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/10/2024
Section Cited
HSC
102423(a)(2)

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This requirement was not met as evidenced by:Each child receiving services from a family child care home shall have certain rights that shall not be waived...To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.
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Licensee removed the trampoline from the facility and agrees to not utilize a trampoline unless using it to the manufacture guidlines
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Based on information received and interviews conducted, the licensee did not comply with the section cited above in 1 count of C1 obtaining a concussion which poses an immediate 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:Megan Aviles
LICENSING EVALUATOR NAME:Sydney Sims
LICENSING EVALUATOR SIGNATURE:
DATE: 07/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/09/2024


LIC809 (FAS) - (06/04)
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