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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340300765
Report Date: 10/01/2021
Date Signed: 10/01/2021 10:48:17 AM

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:WONDER LAND SCHOOLFACILITY NUMBER:
340300765
ADMINISTRATOR:PAULA MARTINEZFACILITY TYPE:
850
ADDRESS:3300 WALNUT AVENUETELEPHONE:
(916) 481-1798
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:55CENSUS: 9DATE:
10/01/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Paula MartinezTIME COMPLETED:
11:10 AM
NARRATIVE
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At 9:00 a.m. on Friday, October 1st, 2021, Licensing Program Analyst (LPA) Karyn Guerra met with Director, Paula Martinez, for the purpose of an unannounced, case management - incident inspection. The purpose of today's inspection was to follow up on a self-reported incident received by the department on September 21st, 2021. Incident occurred on September 20th, 2021. During today's inspection, LPA conducted interviews, gathered documents, and made observations. Facility self reported that Child 1 (C1) was administered medication that was not prescribed to them. Medication was instead prescribed for Child 2 (C2). This poses an immediate risk to the health and safety of children in care. Director stated that both children were new to the facility and there was a mix up. Director stated that parents were immediately notified and poison control was contacted. Director stated that C1 was observed and did not have any adverse reaction.

Title 22 deficiencies are cited on the subsequent pages of this report. Director acknowledges, that FOR TYPE A DEFICIENCIES ONLY upon receipt, licensee shall post LIC 809D 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 licensee. LIC 9224 and Appeal Rights were provided. Director's signature on this report acknowledges receipt of these rights. This report was reviewed with the Director. An exit interview was conducted. A Notice of Site Visit was provided and shall remain posted for a period of 30 days for parental review.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2021
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: WONDER LAND SCHOOL
FACILITY NUMBER: 340300765
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/01/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/11/2021
Section Cited

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101226 Health-Related Services (e) In centers where the licensee chooses to handle medications: (3) Prescription medications may be administered if all of the following conditions are met: (A) Prescription medications shall be administered in accordance with the label directions as prescribed by the child's physician. This requirement was not met, as evidenced by:
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Based on interviews and reports Child 1 (C1) was administered medication that was not prescribed to them by C1's physician. Medication administered was prescribed for C2. This poses an immidiate health and safety risk to children 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: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:
DATE: 10/01/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/01/2021
LIC809 (FAS) - (06/04)
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