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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093617568
Report Date: 06/20/2023
Date Signed: 06/20/2023 12:31:27 PM


Document Has Been Signed on 06/20/2023 12:31 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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:BEELOVED FARM PLAYSCHOOL CHILDREN'S CENTERFACILITY NUMBER:
093617568
ADMINISTRATOR:HODGKIN, KELLYFACILITY TYPE:
850
ADDRESS:2947 PONDEROSA ROADTELEPHONE:
(530) 676-5683
CITY:SHINGLE SPRINGSSTATE: CAZIP CODE:
95682
CAPACITY:42CENSUS: 5DATE:
06/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Shayne HodgkinTIME COMPLETED:
01:00 PM
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Licensing Program Analyst Erwina Pascual-Golamco (LPA) met with Acting Director, Shayne Hodgkin, for an unannounced annual inspection. LPA toured the facility, including all activity and classroom spaces, restrooms, and outdoor play areas. Census included 5 preschool children being supervised by the Director. Another staff member was called during inspection. Director was reminded never to exceed the conditions, limitations, and capacity specified on the license. Facility hours of operation are Tuesday through Friday from 8:15 AM to 2:30 PM during regular School Year, and 8:30 AM to 1:00 PM during Summer Camp.

Director 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.



Classrooms are clean, including the carpets and floors, and are free from hazards. Chemicals were kept inaccessible to children. Bathrooms were observed and all sinks and toilets were sanitary and in operating condition. There are no firearms or bodies of water on the premises and the facility has at least one functioning smoke and carbon monoxide detector. There is First Aid equipment available. LPA observed all required licensing documentation was posted for parental review. LPA observed that parents are signing their children in and out of the center.

The facility provides morning snack, and the families provide their own lunch, with minimal food preparation. LPA observed a posted menu and observed food stored at safe temperatures. Uncontaminated drinking water was readily available to children both indoors and outdoors, and children bring their own water bottles from home. Outdoor play area were inspected and is in good condition. The facility is following a Waldorf Program.

SUPERVISOR'S NAME: Natalie DunawayTELEPHONE: (916) 584-3508
LICENSING EVALUATOR NAME: Erwina Pascual-GolamcoTELEPHONE: (916) 206-1524
LICENSING EVALUATOR SIGNATURE:
DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/20/2023
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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: BEELOVED FARM PLAYSCHOOL CHILDREN'S CENTER
FACILITY NUMBER: 093617568
VISIT DATE: 06/20/2023
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Children and staff files were reviewed. Technical assistance was provided regarding the required licensing documentation in the children's files. LPA reviewed staff transcripts and observed staff caring for children were qualified. At least one staff had a current Pediatric CPR and First Aid certification. Technical assistance was provided regarding Mandated Reporter certificates and proof of immunizations. LPA observed a current children's roster and a fire drill log.

Incidental Medical Services (IMS) were discussed. For additional IMS information, Director was advised to see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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 was encouraged to visit the department's website at WWW.CCLD.CA.GOV for information regarding childcare updates, PINs, forms, regulations and legislation pertaining to childcare centers.

Deficiencies were cited during today's inspection. This report was reviewed with Director, and an exit interview was conducted. Appeal Rights and A Notice of Site Visit (NOS) was provided to Director, who will post it for a period of 30 days for parental review.

SUPERVISOR'S NAME: Natalie DunawayTELEPHONE: (916) 584-3508
LICENSING EVALUATOR NAME: Erwina Pascual-GolamcoTELEPHONE: (916) 206-1524
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/20/2023 12:31 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827


FACILITY NAME: BEELOVED FARM PLAYSCHOOL CHILDREN'S CENTER
FACILITY NUMBER: 093617568

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/20/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in 2 out of 2 staff files did not have a mandated reporter training poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/11/2023
Plan of Correction
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Director will email LPA by end of POC due date attestation that they have completed mandated reporter training, and will place certificates in their files. Director understands these trainings are to be renewed every 2 years.
Type B
Section Cited
CCR
101220.1(g)
Immunizations
(g) The licensee shall document each child's immunizations and shall maintain such documentation in the center for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in 3 out of 5 children's files did not have copies of immunizations for review which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/11/2023
Plan of Correction
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Director will email LPA by end of POC due date attestation that they have copies of immunizations that are missing in children's files.
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: Natalie DunawayTELEPHONE: (916) 584-3508
LICENSING EVALUATOR NAME: Erwina Pascual-GolamcoTELEPHONE: (916) 206-1524
LICENSING EVALUATOR SIGNATURE:
DATE: 06/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/20/2023
LIC809 (FAS) - (06/04)
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