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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313610173
Report Date: 03/07/2022
Date Signed: 03/07/2022 03:11:29 PM

Document Has Been Signed on 03/07/2022 03:11 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:S.T.A.R. TWELVE BRIDGESFACILITY NUMBER:
313610173
ADMINISTRATOR:ATTARAN, JESTINEFACILITY TYPE:
840
ADDRESS:2450 EASTRIDGE DR.TELEPHONE:
(916) 434-6542
CITY:LINCOLNSTATE: CAZIP CODE:
95648
CAPACITY: 100TOTAL ENROLLED CHILDREN: 100CENSUS: 34DATE:
03/07/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Kristina Fiffick (Perry)TIME COMPLETED:
03:45 PM
NARRATIVE
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LPAs Amanda Blesi and Amanda Sutter met with lead teacher Kristina Fiffick. for a case management visit on this date to discuss the unusual incident report (UIR) that was received in the Sacramento Regional office on 2/28/22. During today's inspection, the facility playground was toured, and children were interviewed. Present were 34 school age children and 4 staff. LPA’s learned that there was a lack of supervision on the kindergarten playground which resulted in three children having an inappropriate interaction which was sexual in nature. Staff stated they were unaware of the incident until information was provided by the parent of one of the children. It is unknown exactly when the incident occurred but it is believed to have been in the last couple of weeks.

Based on the Unusual Incident Report and interviews, LPA’s concluded the facility staff did not provide adequate supervision when the day care children were on the playground. This poses an immediate health and safety risk to persons in care. Ms. Fiffick states that since they learned of the incident, they have increased supervision on the playground and made changes to the number of children using the playground at a time. If there is a large group of children in care half of the group will be inside, and the other half will be outside, and they will alternate. They also reviewed playground rules with children and created more defined boundaries to ensure more visual supervision.

Deficiency is cited on the attached LIC809-D.

LPAs Amanda Blesi and Amanda Sutter informed facility representative Kristina Fiffick that this report dated 3/2/22 document(s) one Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care. Also, LPA’s Amanda Blesi and Amanda Sutter informed the facility representative to provide a copy of this licensing report dated 3/2/22 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. Appeal rights were provided.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the facility representative Kristen Fiffick.

Keven Peters
Amanda Blesi
DATE: 03/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2022
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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Document Has Been Signed on 03/07/2022 03:11 PM - It Cannot Be Edited


Created By: Amanda Blesi On 03/07/2022 at 02:54 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: S.T.A.R. TWELVE BRIDGES
FACILITY NUMBER: 313610173

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/07/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/08/2022
Section Cited

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Responsibility for Providing Care and Supervision:(a)The licensee shall provide care and supervision as necessary to meet the
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children's needs. This requirement was not met as evidenced by: an unusual incident report was received which states three children engaged in inappropriate play that was sexual in nature while on the playground.
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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:Keven Peters
TELEPHONE:
LICENSING EVALUATOR NAME:Amanda Blesi
TELEPHONE:
LICENSING EVALUATOR SIGNATURE:
DATE: 03/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2022


LIC809 (FAS) - (06/04)
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