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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340300156
Report Date: 10/10/2019
Date Signed: 10/10/2019 02:07:02 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:CORDOVA BAPTIST PRESCHOOLFACILITY NUMBER:
340300156
ADMINISTRATOR:HUPPERT, CARRIEFACILITY TYPE:
850
ADDRESS:10527 COLOMA ROADTELEPHONE:
(916) 638-5506
CITY:RANCHO CORDOVASTATE: CAZIP CODE:
95670
CAPACITY:87CENSUS: 38DATE:
10/10/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Carrie HuppertTIME COMPLETED:
02:30 PM
NARRATIVE
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Licensing Program Analyst (LPA), Jan Hoshida, conducted an unannounced random annual inspection today. LPA met with Director, Carrie Huppert. A tour of the facility was conducted inside and outside. The following areas are in compliance during the visit. Firearms and ammunition are not on the premises. Storage for poisons are locked. Disinfectants, hazardous items and medications are inaccessible to children. Furniture and equipment are sufficient, age appropriate and in good repair. Fire drills are conducted and documented. The playground equipment and outdoor activity space is maintained and in good condition. Wood chips are being used as cushioning. Children's toilets, hand washing facilities are sanitary. Floors are clean and free of debris. Food preparation area is clean, food is protected from contamination, storage containers for solid waste are covered and all food or beverages are stored in covered containers and labeled. Drinking water is available both indoors and outside. Menus are posted. The facility is in compliance with conditions and limitations specified on the license. Sign in/sign out sheets are maintained. No excluded individuals are present. Staff subject to a criminal record clearance or exemption are associated to the facility. First Aid/CPR reviewed and in compliance. Emergency information reviewed for some children. Some staff records were reviewed. Facility provides a morning and an afternoon snack and children bring their own lunch from home. Facility’s hours of operation are from Monday through Friday from 7:00 am to 6:00 pm. Upon arrival, LPA observed 38 children supervised by four staff members.

LPA did not observe working carbon monoxide detectors installed within the buildings. Director stated that she has taken them down to be replaced since they were 10 years old. Director stated that she has purchased them and will have them installed by maintenance.

During the inspection, LPA and Director walked into an empty classroom and observed a child in the restroom by themselves while their teacher and class mates were outside on the playground. Director stated that she usually helps with these transitions to help children go to the restroom. Director stated that she will re-train staff on maintaining 100% supervision of the children at all times.
REPORT CONTINUED ON NEXT PAGE
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Jan HoshidaTELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2019
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 5
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: CORDOVA BAPTIST PRESCHOOL
FACILITY NUMBER: 340300156
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/10/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/11/2019
Section Cited

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Every licensed child day care center shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. This requirement was not met as evidenced by: LPA did not observe
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carbon monoxide detectors during the inspection. Director stated that she took them down to replace them since they were ten years old.

This poses an immediate risk to the health and safety of the children in care.
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Type A
10/11/2019
Section Cited

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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 was not met by: LPA observed a child alone in the bathroom while their teacher and class
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mates were outside on the playground.

This poses an immediate risk to the health and safety to the children in care.
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corrections inspection.
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: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Jan HoshidaTELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:
DATE: 10/10/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/10/2019
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: CORDOVA BAPTIST PRESCHOOL
FACILITY NUMBER: 340300156
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/10/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/11/2019
Section Cited

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Floor mats used for napping shall be: Maintained in a safe condition with no exposed foam.
This requirement was not met as evidenced by: LPA observed that the sleeping mats had holes and rips with the foam showing through.
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This poses a potential risk to the health and safety to the children in care.
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Type B
11/11/2019
Section Cited

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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.
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This requirement was not met as evidenced by: LPA did not observe complete immunizations for four of the five staff files reviewed.
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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: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Jan HoshidaTELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:
DATE: 10/10/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/10/2019
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: CORDOVA BAPTIST PRESCHOOL
FACILITY NUMBER: 340300156
VISIT DATE: 10/10/2019
NARRATIVE
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LPA observed that the sleeping mats had holes and rips with the foam showing through. Director acknowledged that she is in the process of purchasing new sleeping mats. LPA observed that four of the five staff files reviewed did not have proof of completed immunizations for pertussis, measles and influenza. Director stated that she will obtain proof of immunizations for all staff.

The back play ground area is fenced and there is an in-ground pool on the premises that the facility utilizes during the summer months. The pool is surrounded by a chain linked fence that is at least five feet high and the chain linked fencing is covered with chicken wire so the fence is not climbable. The pool has a self-latching gate that swings away from the pool. The fencing meets Title 22 regulations.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing 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 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

LPA discussed the new Mandated Reporter Training with Director. Beginning January 1, 2018, Health and Safety Code 1596.8662 requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. In addition, existing staff must meet requirements by March 30, 2018. This training requirement may be met by using the Department’s Office of Child Abuse Prevention (OCAP) online training modules. The OCAP modules are free of cost and available at: http://www.mandatedreporterca.com/. The training is currently provided in English. LPA checked facilities fees and confirmed that it is up to date.

LPA provided the Community Care Licensing’s website www.ccld.ca.gov, so the Director can obtain updated licensing information, new regulations and access forms. LPA advised Director of their responsibility to stay current in regards to new regulations. LPA also included the email address for the children's advocacy program to stay current on new laws childcareadvocatesprogram@dss.ca.gov.

REPORT CONTINUED ON NEXT PAGE
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Jan HoshidaTELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2019
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: CORDOVA BAPTIST PRESCHOOL
FACILITY NUMBER: 340300156
VISIT DATE: 10/10/2019
NARRATIVE
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Title 22 Deficiencies have been cited on the attached LIC 809-D. Upon receipt of Type A citations, facility shall post and provide copies of the LIC 809-D for parents/guardians of children currently in care and for parents/guardians of newly enrolled children for the next 12 months. Facility must also keep the signed LIC 9224, Acknowledging Receipt of Licensing Reports LIC 809-D in each child's files

This report was reviewed and discussed with Director. A Notice of Site Visit and appeal rights were provided.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Jan HoshidaTELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2019
LIC809 (FAS) - (06/04)
Page: 5 of 5