033605372-8-29-2019-53-CC-ASRN-BFHRCG-20190829125420

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 033605372
Report Date: 08/29/2019
Date Signed: 08/29/2019 12:54:29 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:	PLYMOUTH STATE PRESCHOOL		FACILITY NUMBER:	033605372
ADMINISTRATOR:	DENISE LANE		FACILITY TYPE:	850
ADDRESS:	18601 SHERWOOD		TELEPHONE:	(209) 257-7853
CITY:	PLYMOUTH	STATE: CA	ZIP CODE:	95669
CAPACITY:	22	CENSUS: 19	DATE:	08/29/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Lory Sage		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	Licensing Program Analysts (LPAs) Aruna Sridharan and Justin Denton met with Site Supervisor Lory Sage for an unannounced annual inspection. Today’s census was 19 preschool aged children and two staff members, who have all been finger-print cleared through Community Care Licensing. LPAs toured the facility including all activity/classroom areas, food service area and restrooms. The Site Supervisor stated that the facility provided breakfast through the school district; LPAs observed a current menu posted on the parent board. The facility operates Monday-Friday 8:15am-11:15am. Medications, disinfectants, cleaning solutions, and hazardous items were appropriately stored and 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. Toileting facilities were in operating, safe, and sanitary condition. Drinking water is made readily available to children both indoors and outdoors. LPAs reviewed care and supervision of children and staffing ratios, there is one teacher for every eight children in care, the facility must follow Title 5's ratio Regulations. LPAs reviewed 4 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. LPAs also reviewed staff's educational background /transcripts, and the facility has the appropriate staffing that meet the educational requirements. LPAs discussed Departments inspection authority regulations with the Site Supervisor and informed her that if any changes occur regarding the Designee/Director or an employee acting in their absence must be reported to Department within 10 working days. 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: 08/29/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2019

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: PLYMOUTH STATE PRESCHOOL	FACILITY NUMBER: 033605372
	VISIT DATE: 08/29/2019

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LPAs also discussed Unusual Incident Reports (UIRs) and reporting requirements. LPAs 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.

LPAs provided the Community Care Licensing’s website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPAs advised the licensee of their responsibility to stay current in regards to new regulations.

LPAs discussed the new Immunization Regulations SB 792, the requirement that all individuals working or volunteering at a licensed Child Care facility must have vaccinations. LPAs conducted file reviews and LPAs observed proof that the facility staff has been vaccinated against Measles, Pertussis and Influenza.

LPAs 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.

LPAs advised the licensee on the new regulation AB 1207- California Child Care Worker: Mandated Reporter Training. The licensee must complete the training every two years starting January 1, 2018 and retain proof of completion in the facility file. The training can be could at: mandatedreporterca.com.

In the areas that were evaluated, no deficiencies were cited during the inspection. LPA read this report to the Site Supervisor; stated that understands today’s inspection. Notice of Site Visit posted and the Site Supervisor 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: 08/29/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2019

LIC809 (FAS) - (06/04)

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