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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 033606959
Report Date: 10/02/2019
Date Signed: 10/02/2019 12:26:45 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:IONE STATE PRESCHOOLFACILITY NUMBER:
033606959
ADMINISTRATOR:PIRET LEONETTIFACILITY TYPE:
850
ADDRESS:415 SOUTH IONETELEPHONE:
(209) 274-4788
CITY:IONESTATE: CAZIP CODE:
95640
CAPACITY:24CENSUS: 21DATE:
10/02/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Shannon BlakeTIME COMPLETED:
12:45 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Aruna Sridharan and Amanda Blesi met with Site Supervisor Shannon Blake for an unannounced annual inspection. Today’s census was 21 preschool aged children and two staff members, who have all been fingerprint cleared through the Amador County Office of Education. LPAs toured the facility in room 13 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 8:30am-11:30am.

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. Medications, disinfectants, cleaning solutions, and hazardous items were under the sink and accessible to children. 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 OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Aruna SridharanTELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 5
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: IONE STATE PRESCHOOL
FACILITY NUMBER: 033606959
VISIT DATE: 10/02/2019
NARRATIVE
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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 did not observe proof in the staff files.

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 found at: mandatedreporterca.com. Site Supervisor Shannon stated staff had taken a wrong training.

In the areas that were evaluated, deficiencies were cited during the inspection. LPAs 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 OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Aruna SridharanTELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2019
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: IONE STATE PRESCHOOL
FACILITY NUMBER: 033606959
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/02/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/03/2019
Section Cited

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Buildings & Grounds: Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children. This requirement was not met as evidenced by broken latch on cabinet below sink where cleaning supplies were stored.
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This is an immediate risk to health and safety of children in care.
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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: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Aruna SridharanTELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:
DATE: 10/02/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/02/2019
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: IONE STATE PRESCHOOL
FACILITY NUMBER: 033606959
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/02/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/02/2019
Section Cited

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Personnel Requirements: At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities. This requirement
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was not met. LPAs observed proof of First Aid Card but it was not taken through an approved vendor (EMSA).
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Type B
11/02/2019
Section Cited

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On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child 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
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(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. LPA did not observe certificates for any staff member.
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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: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Aruna SridharanTELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:
DATE: 10/02/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/02/2019
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: IONE STATE PRESCHOOL
FACILITY NUMBER: 033606959
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/02/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/02/2019
Section Cited

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Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health-related services to the child.
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LPAs observed that multiple children's files were missing physician report. This is potential risk to health and safety of the children in care.
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Type B
11/02/2019
Section Cited

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Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure. This requirement was not met as evidenced by staff file reviews.
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Staff#1 and Staff#3 are missing LIC 503.
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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: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Aruna SridharanTELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:
DATE: 10/02/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/02/2019
LIC809 (FAS) - (06/04)
Page: 5 of 5