033606958-10-30-2023-53-CC-LSCT-CX4PGV-20231030111858

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 033606958
Report Date: 10/30/2023
Date Signed: 10/30/2023 11:19:03 AM

Document Has Been Signed on 10/30/2023 11:19 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
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	JACKSON STATE PRECHOOL		FACILITY NUMBER:	033606958
ADMINISTRATOR:	LEONETTI, PIRET		FACILITY TYPE:	850
ADDRESS:	501 ARGONAUT LANE		TELEPHONE:	(209) 257-7778
CITY:	JACKSON	STATE: CA	ZIP CODE:	95642
CAPACITY:	24	CENSUS: 24	DATE:	10/30/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Facility Representative, Jamie Guthrie		TIME COMPLETED:	11:25 AM

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) Lauren Scott and Elizabeth Santiago met with Facility Representative, Jamie Guthrie for the purpose of an unannounced annual inspection. Facility days and hours of operation are Monday-Friday from 8:15 AM to 11:15 AM. There were 24 children present during today's inspection. LPA reviewed the electronic sign in/out book and observed that the children are properly signed in. Facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated. LPA toured the facility inside and out. LPA observed that hazardous items, including disinfectants and cleaning solutions were inaccessible to children in care. LPA reviewed staffing ratios, first aid supplies, fire drills and drinking water. LPA observed the furniture and equipment to be in good condition. LPA observed all required forms to be posted. LPA observed functioning carbon monoxide and smoke alarms. There are adequate toys and equipment available for children. Outdoor play area was toured, the play equipment appeared to be in good repair. Facility provides breakfast to children in care. All food is prepared off site by the school district. LPA reviewed children’s and staff files. LPA observed health screening reports with TB test and required MMR and TDAP vaccines for all adults and children. At least one staff member present today has current Pediatric CPR and First Aid. LPA observed AB1207 Mandated Reporter training certificates for all staff. The site supervisor was reminded to renew the course every 2 years through www.mandatedreporterca.com website. Report continues on 809-C

SUPERVISOR'S NAME: Chayntel Hunter	TELEPHONE: (916) 917-8620
LICENSING EVALUATOR NAME: Lauren Scott	TELEPHONE: (916) 926-9488
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: JACKSON STATE PRECHOOL	FACILITY NUMBER: 033606958
	VISIT DATE: 10/30/2023

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/

LPA referred facility representative to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Exit interview conducted and report was reviewed with Instructional Aide, Jamie Guthrie. A notice of site visit was given and must remain posted for 30 days.

In the areas that were evaluated, no deficiencies were cited during the inspection.

SUPERVISOR'S NAME: Chayntel Hunter	TELEPHONE: (916) 917-8620
LICENSING EVALUATOR NAME: Lauren Scott	TELEPHONE: (916) 926-9488
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023

LIC809 (FAS) - (06/04)

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