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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340300201
Report Date: 07/06/2023
Date Signed: 07/06/2023 03:24:45 PM


Document Has Been Signed on 07/06/2023 03:24 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:EL RANCHO NURSERY SCHOOLFACILITY NUMBER:
340300201
ADMINISTRATOR:RITCHIE, ANNEFACILITY TYPE:
850
ADDRESS:5636 EL CAMINO AVETELEPHONE:
(916) 482-8656
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:62CENSUS: 14DATE:
07/06/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Holly Olson and Rosalia AvilaTIME COMPLETED:
03:40 PM
NARRATIVE
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On Thursday July 6, 2023, at approximately 1:30 PM Licensing Program Analyst (LPA) Josiah Gathing met with Assistant Director Holly Olson and Facility Representative Rosalia Avila for an unannounced case management investigation. The purpose of today's visit was to follow up on a self-reported incident in which a child required medical attention during swimming pool activities. LPA conducted interviews, reviewed documentation, and made observations during the investigation. LPA determined that the incident resulted from insufficient supervision. Additionally, current water safety training certification for the staff present during the incident was not made available during the investigation. However, at least one staff member with water safety training certification is currently employed with the facility. Deficiencies have been cited on the following pages.

Title 22 deficiencies are cited on the subsequent pages of this report. Assistant Director acknowledges, that FOR TYPE A DEFICIENCIES ONLY upon receipt, licensee shall post LIC 9099D 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 Assistant Director. LIC 9224 and Appeal Rights were provided. Assistant Director's signature on this report acknowledges receipt of these rights. This report was reviewed with the Assistant Director. An exit interview was conducted. A Notice of Site Visit was provided and shall remain posted for a period of 30 days.
Upon receipt, facility representative shall post and provide copies of this licensing report to parents/ guardians of children who are currently enrolled as well as parents/ guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must acknowledge receipt of this report and citation by signing a LIC9224, “ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS”. A copy of this form should be placed in each child file upon receipt from parent.
LPA discussed this report with Assistant Director and conducted an exit interview. LPA also provided appeal rights. Notice of site visit posted.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Josiah GathingTELEPHONE: (916) 799-9668
LICENSING EVALUATOR SIGNATURE:
DATE: 07/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/06/2023
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 07/06/2023 03:24 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: EL RANCHO NURSERY SCHOOL
FACILITY NUMBER: 340300201

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/07/2023
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision...(1) No child(ren) shall be left without the supervision of a teacher at any time...
This requirement was not met as evidenced by:
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Assistant Director will state in writing that a water safety trained staff member will always be present during swim activities and an additional staff member will be required for swimming pool supervision.
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Based on interviews the facility did not comply with the above regulation as a child was not sufficiently supervised in the swimming pool which poses Health, Safety, or Personal Rights risk to persons in care
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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: Josiah GathingTELEPHONE: (916) 799-9668
LICENSING EVALUATOR SIGNATURE:
DATE: 07/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/06/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3


Document Has Been Signed on 07/06/2023 03:24 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: EL RANCHO NURSERY SCHOOL
FACILITY NUMBER: 340300201

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/07/2023
Section Cited
CCR
101216.6(a)

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101216.6 Staffing for Water Activities (a) There shall be at least one adult who has a valid water-safety certificate on file at the center present during water activities...
This requirement was not met as evidenced by:
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Assistant Director will state in writing that a water safety trained staff member will always be present during swim activities.
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Based on interviews the facility did not comply with the above regulation as staff with water training certification was not present during swimming pool activities which poses Health, Safety, or Personal Rights risk to persons in care
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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: Josiah GathingTELEPHONE: (916) 799-9668
LICENSING EVALUATOR SIGNATURE:
DATE: 07/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/06/2023
LIC809 (FAS) - (06/04)
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