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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 293621897
Report Date: 10/08/2024
Date Signed: 10/08/2024 12:35:45 PM


Document Has Been Signed on 10/08/2024 12:35 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:PLAY DATE PRESCHOOL & DAYCAREFACILITY NUMBER:
293621897
ADMINISTRATOR:ROSS, TYLERFACILITY TYPE:
850
ADDRESS:10114 DORCHESTER DR, SUITE 101TELEPHONE:
(530) 798-1971
CITY:TRUCKEESTATE: CAZIP CODE:
96161
CAPACITY:42CENSUS: 25DATE:
10/08/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Tyler RossTIME COMPLETED:
12:40 PM
NARRATIVE
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At approximately 10:05am on 10/8/2024, Licensing Program Analyst (LPA) Matthew Gallo met with facility representative Tyler Ross for the purpose of an unannounced annual random inspection. During the visit, LPA observed a total census of 25 preschool children supervised by 4 staff. The facility hours of operation are 7:30am-5:30pm, Monday-Friday, year round.

LPA toured the building including all activity and classroom spaces, restrooms, food service and outdoor play areas. All necessary postings were observed. Facility representative 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 floors were clean throughout the facility. Playground equipment and surfaces were free of loose or sharp parts, and the areas underneath or around climbing equipment were sufficiently cushioned with sand. Program provides AM&PM snacks and children bring lunch from home. The food preparation space was free of litter, all food was protected against contamination, and storage containers with solid waste had tight-fitting covers. Drinking water was readily available to children both indoors and outdoors. The facility uses an electronic sign-in/sign-out system which LPA observed to being used. Medication was properly stored and inaccessible to children. LPA observed sufficient napping equipment.

Six 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. However, LPA observed that 3 of the 4 staff files did not have signed physician health screenings verifying good health. Criminal record clearances were verified, and facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated. Report continues on 809-C

SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Matthew GalloTELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:
DATE: 10/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/08/2024
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: PLAY DATE PRESCHOOL & DAYCARE
FACILITY NUMBER: 293621897
VISIT DATE: 10/08/2024
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

LPA referred facility representative to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

Director 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.

Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

A Title 22 deficiency is cited on the accompanying 809-D



Exit interview conducted and report was reviewed with the facility representative, Tyler Ross. A notice of site visit was given and must remain posted for 30 days. LPA provided facility representative with appeal rights.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Matthew GalloTELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/08/2024 12:35 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: PLAY DATE PRESCHOOL & DAYCARE

FACILITY NUMBER: 293621897

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 10/08/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 3 out of 4 staff records reviewed, which poses a potential health, safety or personal rights risks to persons in care.
POC Due Date: 11/08/2024
Plan of Correction
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Director Tyler Ross will provide LPA pictures of completed health screenings for the 3 staff by the POC due date. Pictures can be sent by text to 916-208-3734 or by email to matthew.gallo@dss.ca.gov.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Matthew GalloTELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:
DATE: 10/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/08/2024
LIC809 (FAS) - (06/04)
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