093616214-3-4-2020-03-CC-CJAN-BMDVAK-20200304151605

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 093616214
Report Date: 03/04/2020
Date Signed: 03/04/2020 03:16:10 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:	COUNTRY KIDS DAYCARE & PRESCHOOL		FACILITY NUMBER:	093616214
ADMINISTRATOR:	SPRINGER, ASHLEE		FACILITY TYPE:	830
ADDRESS:	610 PLEASANT VALLEY ROAD		TELEPHONE:	(530) 642-1630
CITY:	DIAMOND SPRINGS	STATE: CA	ZIP CODE:	95619
CAPACITY:	8	CENSUS: 5	DATE:	03/04/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:05 PM
MET WITH:	Ashle Springer		TIME COMPLETED:	03:30 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 03/04/2020 Licensing Program Analysts (LPAs) Christopher Jackson and Michelle Pascual conducted an unannounced annual random inspection for the infant program. LPAs met with Director Ashlee Springer. A tour of the infant area was conducted. 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, mats, and feeding chairs are sufficient, age appropriate and in good repair. Toys are safe, without sharp points, edges, splinters or small parts that can be pulled off and swallowed. During today's inspection LPAs observed the floors are clean and free of debris. At 1:15 PM LPAs observed the facility to be in compliance with staff infant ratios. All infants including those napping in cribs are under visual observation at all times. At 1:20 PM LPA inquired with staff about Infant changing. Staff stated the changing takes place on floor. LPAs observed the padded surface no less than one inch thick, covered with washable vinyl or plastic, and have raised sides at least three inches high and is within arms reach of the sink. Feeding plans reviewed for three infants. Needs and Services plans reviewed for three infants. Sign in/Sign 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. There are no bodies of water on the premises. Firearms and ammunition are not on the premises. Storage area for poisons is locked. Disinfectants, hazardous items and medications are inaccessible to children. Fire drills are conducted every monthly and documented. The facility is in compliance with conditions and limitations specified on the license. LPAs observed a functioning smoke and carbon monoxide detectors during today's inspection. All staff subject to a criminal record clearance or exemption are associated to the facility. First Aid/CPR reviewed and at least one staff on site has proof of CPR. Emergency information reviewed for three infants in care. Two staff records reviewed contain documentation of the educational background, training, and/or experience. Operating hours are Monday thru Friday; 7:30 AM to 5:30 PM. Report Continues on 809-C

SUPERVISOR'S NAME: Sharon Ogbodo	TELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Christopher Jackson	TELEPHONE: (916) 216-8837
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2020

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: COUNTRY KIDS DAYCARE & PRESCHOOL	FACILITY NUMBER: 093616214
	VISIT DATE: 03/04/2020

NARRATIVE

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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.

LPA discussed the new Mandated Reporter Training with licensee. LPAs discussed the two year requirement to update the training. The OCAP modules are free of cost and available at: http://www.mandatedreporterca.com/. The training is currently provided in English.

LPAs checked facilities fees and confirmed that it is up to date.

LPAs provided the Community Care Licensing website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA advised licensee 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. LPA provided a copy of the updated immunization record (CDPH 286). In addition LPAs provided the handout on proposed safe sleep regulations and "The Effects of Lead Exposure" flyer.

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

SUPERVISOR'S NAME: Sharon Ogbodo	TELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Christopher Jackson	TELEPHONE: (916) 216-8837
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2020

LIC809 (FAS) - (06/04)

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