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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045402335
Report Date: 11/04/2022
Date Signed: 11/30/2022 01:47:36 PM

Document Has Been Signed on 11/30/2022 01:47 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-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:PAIERI, GINA FAMILY CHILD CARE HOMEFACILITY NUMBER:
045402335
ADMINISTRATOR:PAIERI, GINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 519-3655
CITY:CHICOSTATE: CAZIP CODE:
95926
CAPACITY: 14TOTAL ENROLLED CHILDREN: 3CENSUS: 3DATE:
11/04/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Gina Paieri, LicenseeTIME COMPLETED:
11:00 AM
NARRATIVE
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On 11/4/22 at 8:15am, an annual inspection was made to the facility by Licensing Program Analyst (LPA), Erica Laird and Licensing Program Manager (LPM) Megan Aviles. Due to technical issues, this report is being opened to generate a 809-D

Notice of Site Visit shall be posted for 30 days from today's visit.

The following Title 22 deficiency was cited during today's visit. See LIC 809-D.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Erica Laird
LICENSING EVALUATOR SIGNATURE: DATE: 11/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2022
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 11/30/2022 01:47 PM - It Cannot Be Edited


Created By: Erica Laird On 11/04/2022 at 09:59 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: PAIERI, GINA FAMILY CHILD CARE HOME
FACILITY NUMBER: 045402335

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/04/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/04/2022
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 of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
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The licensee agrees to provide proof of completion of the required Mandated Reporter Training. The plan of correction shall be submitted to CCLD on or before 12/04/2022.

mandatedreporterca.gov
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Based on interview and file review, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
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LPA, Erica Laird
[email protected]

Fax: 530-895-5934
Type B
12/04/2022
Section Cited
CCR102416(c)

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(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.
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The licensee agrees to provide proof of completion of the required CPR/First Aid training. The plan of correction shall be submitted to CCLD on or before 12/4/22.
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Based on interview, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
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LPA, Erica Laird
[email protected]

Fax: 530-895-5934
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:Erica Laird
LICENSING EVALUATOR SIGNATURE:
DATE: 11/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/04/2022


LIC809 (FAS) - (06/04)
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