033616307-9-14-2023-53-CC-MMEK-CVNRPV-20230914131234

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 033616307
Report Date: 06/22/2023
Date Signed: 09/14/2023 03:22:14 PM

Document Has Been Signed on 09/14/2023 03:22 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
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	AMADOR TUOLUMNE COMMUNITY ACTION AGENCY		FACILITY NUMBER:	033616307
ADMINISTRATOR:	FERNER, KATIE		FACILITY TYPE:	830
ADDRESS:	101 SHOPPING DRIVE		TELEPHONE:	(209) 223-1485
CITY:	JACKSON	STATE: CA	ZIP CODE:	95642
CAPACITY:	12	CENSUS: 8	DATE:	06/22/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Site Supervisor Katie Ferner		TIME COMPLETED:	01:20 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	*THIS IS AN AMENDED REPORT DRAFTED ON 9/14/23 FROM INSPECTION DATE OF 6/22/23* Licensing Program Analyst (LPA) Mariya Melnichuk met with Site Supervisor, Katie Ferner for the purpose of an unannounced Annual/Random inspection. There were eight children present during today's inspection. LPA toured the facility inside and out. Facility days and hours of operation are Monday-Friday from 8:30 AM to 2:40 PM, year round. LPA reviewed care and supervision of children, staffing ratios, medications and first aid supplies, furniture, equipment, fire drills and drinking water. LPA observed all required forms to be posted. There were cots available for infants over 12 months old. There are needs and services plans for each infant and toddler enrolled. LPA observed that hazardous items (disinfectants, cleaning solutions etc.) were inaccessible to children in care. LPA observed a changing table within arm's reach of the sink. There are adequate toys and equipment available for children. Outdoor play area was toured, the play structure for the toddlers appeared to be in good repair, there is sufficient cushioning under the play structure to prevent the fall. LPA reviewed the sign in/out book and observed that the children are properly signed in/out. All staff present during today's inspection have a fingerprint clearance. Facility Representative was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated. Children and staff files were reviewed. Each child's file contained an emergency card and other required documents. LPA observed required documents, including health screening reports with TB test and required MMR and TDAP vaccines, for staff. At least one staff member present today has current Pediatric CPR and First Aid (08/2023). 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: Mariya Melnichuk	TELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023

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: AMADOR TUOLUMNE COMMUNITY ACTION AGENCY	FACILITY NUMBER: 033616307
	VISIT DATE: 06/22/2023

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. Facility has a plan in place. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 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) toll-free 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: http://www.ada.gov/childqanda.htm

LPA discussed the safe sleep regulations with Facility Representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Facility Representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. LPA discussed the requirement to check and log infant napping every 15 minutes / observed 15min infant napping logs for infants 24 months and under. LPA provided a copy of LIC 9227 Individual Sleeping Plan for infants under 12 months during today's inspection, per safe sleep regulations.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website atwww.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Exit interview conducted and report was reviewed with the Facility Representative. A notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

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: Mariya Melnichuk	TELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

LIC809 (FAS) - (06/04)

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