030319700-11-15-2019-53-CC-ASRN-BHXSGB-20191115125141

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 030319700
Report Date: 11/15/2019
Date Signed: 11/15/2019 12:52:02 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME:	PIONEER ELEMENTARY PRESCHOOL		FACILITY NUMBER:	030319700
ADMINISTRATOR:	JESSICA VAUGHN		FACILITY TYPE:	850
ADDRESS:	24625 HIGHWAY 88		TELEPHONE:	(209) 295-6503
CITY:	PIONEER	STATE: CA	ZIP CODE:	95666
CAPACITY:	24	CENSUS: 16	DATE:	11/15/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Jessica Vaughn		TIME COMPLETED:	01:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	At 10:00am Licensing Program Analyst (LPA) Aruna Sridharan and Licensing Program Manager Sharon Ogbodo met with Jessica Vaughn for the purpose of an unannounced annual inspection. Today’s census was 16 children and two staff members, who have all been fingerprint cleared through Amador County of Education LPA toured the building including all activity and classroom #3 space, restrooms, food service, and outdoor play areas. LPA observed appropriate ratios, care and supervision, and capacity during the visit. The hours of operation are Monday through Friday 7:45am to 10:45am. The school year began on Aug 14, 2019 and last day is June 5, 2020. The facility has two waivers, one for shared playgorund usage and the other for use of shared bathrooms. Medications, disinfectants, cleaning solutions, and hazardous items were appropriately stored and inaccessible to children. First Aid was centrally located but inaccessible to children. Furniture, equipment, and play materials were in good condition. Playground equipment was free of loose and sharp parts. The areas under and around playground climbing equipment were cushioned with wood chips to absorb falls. They have access to upper playground which is used on Fridays usually. The Director stated there are no firearms or bodies of water on the property. There are 3 toilets and 2 sinks. Toileting facilities were in operating, safe, and sanitary condition. Trash cans containing solid wastes had lids. Uncontaminated drinking water is readily available to children both indoors and outdoors. The Director stated that the facility provided breakfast at 8:00am through the school in the cafeteria. LPA observed a current menu posted. LPA observed Sign In/Out Sheet with signatures, times, and dates. Report continues on 809C page......

SUPERVISOR'S NAME: Sharon Ogbodo	TELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Aruna Sridharan	TELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2019

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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: PIONEER ELEMENTARY PRESCHOOL	FACILITY NUMBER: 030319700
	VISIT DATE: 11/15/2019

NARRATIVE

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LPA reviewed 3 children’s files and observed that each child had their Identification/Emergency Information and the Consent for Medical Treatment form filled out and signed by their authorized representative At least one staff member present today had current Pediatric CPR and First Aid certification (expires 11//21). All staff currently employed with the facility have proof of immunizations. LPA also reviewed documentation of qualifications including education and experience. LPA discussed the Departmental inspection authority, and also informed the Licensee that any changes regarding the Center Director or their Designee must be reported to Department within 10 working days.
LPA also discussed Unusual Incident Reports (UIRs) and reporting requirements. LPA informed the Director that if any unusual incidents occur she must contact the Department within 24 hours and an UIR must be submitted with 7 day, describing the specifics to the incident.
LPA discussed the new Immunization Regulations SB 792, the requirement that all individuals working or volunteering at a licensed Child Care facility must have vaccinations.
LPA provided the Community Care Licensing’s website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA advised the licensee of their responsibility to stay current in regards to new regulations.
LPA discussed the Incidental Medical Services (IMS) policies with the licensee. The facility is not currently providing IMS; however, LPA discussed the IMS policy. For IMS information see the Evaluator Manual Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and Medication Regulations 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ), ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: www.ada.gov/childqanda.

Report continues on 809C....

SUPERVISOR'S NAME: Sharon Ogbodo	TELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Aruna Sridharan	TELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2019

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: PIONEER ELEMENTARY PRESCHOOL	FACILITY NUMBER: 030319700
	VISIT DATE: 11/15/2019

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	No Title 22 Deficiencies observed in the areas that were evaluated. LPA reviewed report and provided copies to the facility. An exit interview was conducted. Appeal Rights were provided and Notice of Site Visit posted and the director understands it must remain posted for 30 days.

SUPERVISOR'S NAME: Sharon Ogbodo	TELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Aruna Sridharan	TELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2019

LIC809 (FAS) - (06/04)

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