053604817-6-22-2023-53-CC-LSCT-CT2SVY-20230622141330

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 053604817
Report Date: 06/22/2023
Date Signed: 06/22/2023 02:13:34 PM

Document Has Been Signed on 06/22/2023 02:13 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:	MICHELSON EXTENDED DAY PROGRAM		FACILITY NUMBER:	053604817
ADMINISTRATOR:	KRISTIAN LERETTE		FACILITY TYPE:	840
ADDRESS:	196 PENNSYLVANIA GULCH ROAD		TELEPHONE:	(209) 736-6098
CITY:	MURPHYS	STATE: CA	ZIP CODE:	95247
CAPACITY:	49	CENSUS: 16	DATE:	06/22/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Site Supervisor, Amy Sturdivant		TIME COMPLETED:	02:15 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 Analyst (LPA) Lauren Scott met with Site Supervisor, Amy Sturdivant, for the purpose of an unannounced annual inspection. There were 16 children present at the time of the inspection. LPA reviewed the sign in/out book and observed that the children are properly signed in/out. During the school year, facility days and hours of operation are Monday - Friday from 2:00 PM to 6:00 PM. During summer, hours are 7:30AM-5:30PM Monday-Friday. LPA toured the facility inside and out. LPA observed that hazardous items (disinfectants, cleaning solutions, etc.) were inaccessible to children in care. LPAs observed the following items during today's inspection: care and supervision of children, staffing ratios, first aid supplies, furniture, equipment, and access to drinking water. Facility provides snack during the school year and breakfast, lunch and snack during summer. All food is prepared on site. Kitchen was toured at time of inspection. LPA observed all required forms to be posted. Outdoor play area was toured, the play structure appeared to be in good repair, and there is sufficient cushioning (rubber mulch) under the play structure. 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. 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: 06/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023

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: MICHELSON EXTENDED DAY PROGRAM	FACILITY NUMBER: 053604817
	VISIT DATE: 06/22/2023

NARRATIVE

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LPA observed health screening reports with TB test and required MMR and TDAP vaccines. 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 facility was reminded to renew the course every 2 years through www.mandatedreporterca.com website.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing 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.

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 at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Exit interview conducted and report was reviewed with site supervisor, Amy Sturdivant. 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: Lauren Scott	TELEPHONE: (916) 926-9488
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023

LIC809 (FAS) - (06/04)

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