<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 293605858
Report Date: 05/23/2023
Date Signed: 05/23/2023 04:23:23 PM


Document Has Been Signed on 05/23/2023 04:23 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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833



FACILITY NAME:T.D.R.P.D. GLENSHIRE KID'S KORNERFACILITY NUMBER:
293605858
ADMINISTRATOR:JOHNSON, KATRINAFACILITY TYPE:
840
ADDRESS:10990 DORCHESTERTELEPHONE:
(530) 448-1103
CITY:TRUCKEESTATE: CAZIP CODE:
96161
CAPACITY:36CENSUS: DATE:
05/23/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Mason MoomeyTIME COMPLETED:
04:35 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
At approximately 1:25pm, Licensing Program Analyst (LPA) Matthew Gallo met with facility representative Mason Moomey for the purpose of an unannounced annual random inspection. During the course of the inspection, LPA observed a total census was 31 school-aged children supervised by 1 qualified teacher and 2 aides. Facility hours of operation are 7:00am-9:00am and 1:00pm to 5:30pm, M-F. Facility does not offer transportation services.

Upon arrival, LPA found classroom empty. After waiting for a minute, LPA was greeted by facility representative Moomey, who stated that the children were currently in the playground and that he had returned to the classroom to retrieve some forgotten keys. LPA walked with facility representative to the playground, where LPA counted 31 children supervised by 1 adult (S1). Minutes later, another adult (S2) who had been inside a school building joined in supervision. Upon record review and interview, LPA determined that Mr. Moomey was a qualified teacher, and that S1 and S2 were aides.

LPA toured the building including all activity and classroom spaces, restrooms, food service and outdoor play areas. All necessary postings were observed. Director stated there were no poisons or firearms on the premises, and LPA did not observe any bodies of water. All toxic and hazardous items were inaccessible to children. Functional carbon monoxide detector and smoke detector were present. Furniture and equipment were in good condition, and LPA communicated the importance of regularly checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/, further recommending they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. Playground equipment and surfaces were free of loose or sharp parts, and the areas underneath or around climbing equipment were sufficiently cushioned with wood chips. The floors appeared clean throughout the facility. Program provides snacks, and menus were posted in visible sight. The food preparation space was free of litter and all food was protected against contamination. However, LPA observed several cartons of expired milk in the refrigerator. Drinking water was readily available to children both indoors and outdoors. LPA observed signatures while reviewing the sign in and sign out sheet. Medication was properly stored and inaccessible to children.

SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Matthew GalloTELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:
DATE: 05/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: T.D.R.P.D. GLENSHIRE KID'S KORNER
FACILITY NUMBER: 293605858
VISIT DATE: 05/23/2023
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
26
27
28
29
30
31
32
Staff and children's records were reviewed and observed to be complete. Review of staff records confirmed at least one staff member present today has current Pediatric CPR and First Aid certification, and that all staff currently employed with the facility have valid AB1207 Manded Reporter Training certificates. Criminal record clearances were also verified, and 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.

Facility representative was encouraged to the visit the departments website at WWW.CCLD.CA.GOV for information regarding childcare updates, forms, regulations and legislation pertaining child care centers.

Title 22 deficiencies are cited on the subsequent pages of this report.



Licensee acknowledges, that FOR TYPE A DEFICIENCIES ONLY upon receipt, licensee shall post LIC 809D with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the licensee. LIC 9224 and Appeal Rights were provided.

Exit interview conducted and report was reviewed with the facility representative Mason Moomey. Appeal rights and a Notice of Site Visit were provided, the latter of which must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Matthew GalloTELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 05/23/2023 04:23 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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833


FACILITY NAME: T.D.R.P.D. GLENSHIRE KID'S KORNER

FACILITY NUMBER: 293605858

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 05/23/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101516.5(b)
Teacher-Child Ratio
(b) There shall be a staffing ratio of one teacher and one aide present to every 28 children in attendance.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and interview, the licensee did not comply with the section cited above by having one teacher and two aides supervising 31 children, whereas the proper ratio would require at least 2 qualified teachers. This poses an immediate health, safety, and person rights risk to individuals in care.
POC Due Date: 05/24/2023
Plan of Correction
1
2
3
4
Facility representative states that there are additional teachers employmed at another location that they will coordinate with to ensure there are at least 2 qualified teachers when over 28 children are present. Facility representive will send LPA Gallo a copy of a schedule with the new teachers, and provide their qualifications.
Type A
Section Cited
CCR
101227(a)(19)
Food Service
(a) In child care centers providing meals to children, the following shall apply: (19) All food shall be protected against contamination. Contaminated food shall be discarded immediately.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above by storing several cartons of milk that had expired the previous month in the classroom refrigerator. This poses an immediate healthy, safety or personal rights risk to persons in care.
POC Due Date: 05/24/2023
Plan of Correction
1
2
3
4
Facility will remove milk cartons while LPA is present and acknowledges that any out-of-date foods or beverages need to be discarded immediately.
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: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Matthew GalloTELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:
DATE: 05/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4


Document Has Been Signed on 05/23/2023 04:23 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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833


FACILITY NAME: T.D.R.P.D. GLENSHIRE KID'S KORNER

FACILITY NUMBER: 293605858

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 05/23/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101229(a)(1)

(a) The licensee shall provide care and supervision as necessary to meet the children's needs.

(1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e) (1) and 101230(c)(1). Supervision shall include visual observation.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview, and record review, the licensee did not comply with the section cited above by leaving 31 children in an outdoor play area under the supervision of one aide and no teachers. This poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/24/2023
Plan of Correction
1
2
3
4
Facility representatives states that there are additional teachers employed at another location that they will coordinate with to ensure there are always at least 2 teachers and 1 aide available to supervise children if over 28 children are present.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Matthew GalloTELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:
DATE: 05/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4