093614391-8-9-2021-03-CC-JHOA-C5QS7Q-20210809133756

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 093614391
Report Date: 08/09/2021
Date Signed: 08/09/2021 01:38:03 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:	MS. LISA'S MONTESSORI		FACILITY NUMBER:	093614391
ADMINISTRATOR:	HAYES, LISA		FACILITY TYPE:	830
ADDRESS:	2558 GREENWOOD LANE		TELEPHONE:	(530) 676-9393
CITY:	CAMERON PARK	STATE: CA	ZIP CODE:	95682
CAPACITY:	10	CENSUS: 1	DATE:	08/09/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Maria Mayorga		TIME COMPLETED:	01:45 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	On Monday, 08/09/2021, Licensing Program Analyst (LPA) Jan Hoshida conducted an unannounced annual random inspection for the infant program. LPA met with Owner/Director Lisa Hayes. Upon arrival, LPA observed one infant supervised by one staff member. Owner/Director stated that the program is on break for the week to get ready for the up-coming school year. LPA and Owner/Director conducted a health and safety inspection inside and outside of the facility. The infant indoor and outdoor activity space is physically separate from the space used by other day care children. Infant furniture and equipment, including cribs, and chairs are sufficient, age appropriate and in good repair. Infant changing table has a padded surface no less than one inch thick, covered with washable vinyl or plastic, and has raised sides at least three inches high. Toys are safe, without sharp points, edges, splinters or small parts that can be pulled off and swallowed. Facility is in compliance with staff infant ratios. Owner/Director stated that all infants including those napping in cribs are under visual observation at all times. Feeding plans, Needs and Services plans, Individual Infant Sleeping Plans (LIC 9227), and infant sleep logs reviewed for some infants. Sign in/out sheets have full legal signature and record of time of day. Staff utilized as infant teachers have three child development units in infant/toddler care. Firearms and ammunition are not on the premises. Owner/Director acknowledged that storage area for poisons needs to be locked and stated that there are no poisons on site. Disinfectants, hazardous items, and medications are inaccessible to children. Fire drills are conducted every month and documented. Rooms are safe and clean. The facility is in compliance with conditions and limitations specified on the license. All staff subject to a criminal record clearance or exemption are associated to the facility. First Aid/CPR reviewed and in compliance. *REPORT CONTINUED ON NEXT PAGE*

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jan Hoshida	TELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2021

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: MS. LISA'S MONTESSORI	FACILITY NUMBER: 093614391
	VISIT DATE: 08/09/2021

NARRATIVE

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Emergency information reviewed for some children. Staff records reviewed contain documentation of the educational background, training, and/or experience and, a Health Screening/TB test and immunization records to meet SB 792. Operating hours are Monday through Friday from 7:00 am to 5:30 pm.

LPA discussed current COVID guidelines with Director.

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. Director stated that they currently do not have any children with medication that attend the facility.

LPA provided the Community Care Licensing’s website www.ccld.ca.gov, so the Director can obtain updated licensing information, new regulations and access forms. LPA advised Director of their responsibility to stay current in regards to new regulations. LPA also included the email address for the children's advocacy program to stay current on new laws childcareadvocatesprogram@dss.ca.gov.

No Title 22 Deficiencies observed in the areas that were evaluated. LPA reviewed report with the Director and provided copies. An exit interview was conducted. LPA observed the Notice of Site Visit posted and the Director understands it must remain posted for 30 days.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jan Hoshida	TELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2021

LIC809 (FAS) - (06/04)

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