293614616-6-23-2021-03-CC-BMOS-C49TKK-20210623144806

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 293614616
Report Date: 06/23/2021
Date Signed: 06/23/2021 02:48:11 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:	CARE CAMPUS CHILDREN'S CENTER		FACILITY NUMBER:	293614616
ADMINISTRATOR:	GUSTAVSON, SANDEE		FACILITY TYPE:	840
ADDRESS:	10746 SIERRA ROSE CT.		TELEPHONE:	(530) 268-8252
CITY:	GRASS VALLEY	STATE: CA	ZIP CODE:	95949
CAPACITY:	21	CENSUS: 15	DATE:	06/23/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:40 AM
MET WITH:	Sandee Gustavson - Director		TIME COMPLETED:	03:00 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 Wednesday, June 23rd, 2021, at 11:50am, Licensing Program Analyst (LPA) Blake Morillas met with the Director, Sandee Gustavson, for the purpose of an unannounced Annual Required inspection. At 11:50am, There were no School Age children present due to the program being on a Field Trip to the local Library. At 12:15pm, 15 School Age children and two staff were observed arriving at the facility. This visit was done in tandem with conducting an unannounced Annual Required visit with their Preschool Program, Facility Number 293614615. Operating hours are 6:45am to 5:40pm, Monday through Friday. The facility operates year around. At 12:09pm, LPA initiated a health and safety inspection of all indoor and outdoor areas accessible to children. LPA observed that hazardous items (disinfectants, cleaning solutions, etc.) were inaccessible to children in care. LPA inspected the food service area and observed that the food products appeared to be protected against contamination. Menus were posted. LPA reviewed care and supervision of children, staffing ratios, health related services (including medications and first aid supplies), furniture, equipment, and fire drills logs. LPA observed all required forms to be posted. Sign/in-sign/out sheet were reviewed. Drinking water is readily accessible to children in care inside and outside of the building. LPA observed sinks and toilets to be operable. There are adequate toys, equipment, and supplies available for the children. The outdoor play area was observed to have adequate cushioning material and play equipment to be in safe condition. Shaded areas are also available for the children in care. *Continued on LIC 809-C

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Blake Morillas	TELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021

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: CARE CAMPUS CHILDREN'S CENTER	FACILITY NUMBER: 293614616
	VISIT DATE: 06/23/2021

NARRATIVE

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*Continuation of LIC 809

At 12:36pm, LPA began to review children’s and staff's files. All staff currently employed with the facility have criminal record clearances, health screening reports with TB test, immunizations, and Mandated Reporter training. At least one staff member present today has current Pediatric CPR and First Aid.

LPA provided the Lead Testing brochures (AB 2370) and discussed the current Covid-19 protocols and guidelines.

LPA provided the Licensing Agency website (ccld.ca.gov), so the Director may obtain updated licensing information, regulations, and forms.

Incidental Medical Services (IMS) policy was discussed. When any IMS is provided, an updated Plan of Operation that includes 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 for TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the Americans with Disabilities Act, available at: http://www.ada.gov/childqanda.htm

In the areas that were evaluated, there were no deficiencies at this time.

At 2:30pm, LPA reviewed the report with the Director and an exit interview was conducted.

LPA provided a Notice of Site Visit and a copy of the Appeal Rights (LIC9058). The Director acknowledges that the Notice of Site Visit shall remain posted for 30 days for parental review.

The Director's signature on this form acknowledges receipt of this report and said documents.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Blake Morillas	TELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021

LIC809 (FAS) - (06/04)

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