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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 585407983
Report Date: 01/31/2023
Date Signed: 02/05/2023 01:04:46 PM

Document Has Been Signed on 02/05/2023 01:04 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
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:SOTO, ANA FAMILY CHILD CARE HOMEFACILITY NUMBER:
585407983
ADMINISTRATOR:SOTO, ANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 718-9819
CITY:MARYSVILLESTATE: CAZIP CODE:
95901
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
01/31/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Ana SotoTIME COMPLETED:
04:15 PM
NARRATIVE
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On 1/31/2023 at 2:50pm Licensing Program Analyst (LPA) Laura Chavez conducted a case management inspection to the home and met with Licensee Ana Soto. The inspection is made in response to the licensee failing to secure a subsequent exemption for A1, who resides in the home, as requested in a letter from the Department dated 2/9/2022.

LPA informed licensee Ana Soto that this report dated 1/31/2023 documents one Type A citation 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.

Also, LPA Laura Chavez informed the licensee to provide a copy of this licensing report dated 1/31/2023 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 statements, must be placed in the child's file for verification.

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: Megan Aviles
LICENSING EVALUATOR NAME: Laura Chavez
LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2023
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 02/05/2023 01:04 PM - It Cannot Be Edited


Created By: Laura Chavez On 01/31/2023 at 03:28 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: SOTO, ANA FAMILY CHILD CARE HOME
FACILITY NUMBER: 585407983

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/31/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/01/2023
Section Cited
CCR
102370.1(d)(1)

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Criminal Record Clearance: All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility: Obtain a California clearance or a criminal record
exemption as required by the Department.
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The licensee agrees to have A1 move out of the home by 2/1/2023. A1 shall not reside in the home until an exemption is granted or receives information of A1 allowed to reside in the home while an exemption request is evaluated. An immediate $500.00 Civil Penalty was assessed.
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The licensee agrees to provide a written statement and proof of A1's temporary residence to CCLD on or before 2/1/2023.

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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:Laura Chavez
LICENSING EVALUATOR SIGNATURE:
DATE: 01/31/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/31/2023


LIC809 (FAS) - (06/04)
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