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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340305706
Report Date: 01/26/2022
Date Signed: 01/26/2022 04:25:38 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:FOREVER YOUNG INFANT CARE CENTERFACILITY NUMBER:
340305706
ADMINISTRATOR:TYSON, SELINAFACILITY TYPE:
830
ADDRESS:1209 P STREET #12TELEPHONE:
(916) 446-4246
CITY:SACRAMENTOSTATE: CAZIP CODE:
95814
CAPACITY:20CENSUS: 14DATE:
01/26/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Selina Tyson TIME COMPLETED:
04:45 PM
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Licensing Program Analyst (LPA) Alize Tillery met with Director Selina Tyson for the purpose of an unannounced annual random inspection. Director was reminded never to exceed the conditions, limitations and capacity specified on the license. Upon arrival, LPA observed 14 infant children, supervised by 5 staff. Facility’s hours of operation are Monday through Friday from 7:00 AM to 6:00 PM.

LPA toured all activity and classroom spaces, the kitchen area, the napping area and the outdoor play area. LPA observed documentation of the napping infants every 15 minutes. LPA observed one infant to be sleeping on their tummy. LPA informed Director that children 12 months and under should be placed on their backs when child is put in the crib and must have a Infant Sleeping Plan on file. LPA observed the following documents are posted: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, menus, and daily schedule. Cleaning disinfectants, hazardous items, and medications are appropriately stored and inaccessible to children. Director stated there are no poisons on the premises. Furniture and equipment are in good condition, and toileting facilities are in safe, sanitary and operating condition. LPA observed two changing tables in arms reach of a sink. LPA observed infant food and bottles labeled in the refrigerator. The floors appeared clean throughout the facility. The food preparation space is free of litter, all food was protected against contamination, and storage containers with solid waste have covers.



Drinking water is readily available to children both indoors and outdoors. LPA observed a water pitcher and children’s personal cups. LPA observed full legal signatures while reviewing the sign in and sign out sheet. In the outdoor play area, LPA observed stacked cardboard held down by bricks and storage bins stacked near the children’s outdoor table. Director stated that the landlord was supposed to have these items removed. Director will submit proof to LPA Tillery by 2/9/2022, that the outdoor area has been fixed. There are sufficient amount of equipment and toys; LPA recommended that the equipment outdoors be rinsed off. There are shaded areas supplied by the building.

Report continues on 809-C.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Alize TilleryTELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2022
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 4
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: FOREVER YOUNG INFANT CARE CENTER
FACILITY NUMBER: 340305706
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/26/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101217(d)
Personnel Records
(d) All personnel records shall be maintained at the child care center and shall be available to the licensing agency for review.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in Staff #2 and Staff #4 did not have personnel files for Lpa to review, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/09/2022
Plan of Correction
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Director will send to LPA Tillery proof of complete files for Staff #2 and #4.
Type B
Section Cited
CCR
101419.2(b)(2)
Infant Needs and Services Plan
(b) The needs and services plan shall be in writing and shall include the following: (2) Infants up to 12 months of age shall have a completed Individual Infant Sleeping Plan [LIC 9227 (3/20)], which is incorporated by reference.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in that Director stated that was not aware of the form and did not have one on file for children 12 months and under, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/09/2022
Plan of Correction
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Director will send LIC 9227 forms to LPA Tillery for children 12 months and under.
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: Alize TilleryTELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:
DATE: 01/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/26/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: FOREVER YOUNG INFANT CARE CENTER
FACILITY NUMBER: 340305706
VISIT DATE: 01/26/2022
NARRATIVE
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7 staff files and 7 present day care children file records were reviewed. All children files were observed to be complete, except those children 12 months and younger were missing the LIC 9227 Infant Sleep Plan. All present staff members have criminal record clearances and are listed on the facility roster. 2 present staff members did not have files available for LPA review. At least one staff member present today has current Pediatric CPR and First Aid certification, which expires 2/2022. All staff members are due to retake the Mandated Reporter Training; Director was reminded that all staff are to take the Mandated Reporter Training every 2 years. Director will submit proof of completion to LPA Tillery by 2/9/2022. There are no firearms or bodies of water on the premises. LPA observed a smoke and carbon monoxide detector. LPA reviewed the Department's inspection authority and discussed with designee any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within ten working days. LPA informed Director that the annual fee of $242 is due on 1/31/22.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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



Report continues...
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Alize TilleryTELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: FOREVER YOUNG INFANT CARE CENTER
FACILITY NUMBER: 340305706
VISIT DATE: 01/26/2022
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Licensees was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Deficiencies are cited on the following 809D page. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director, Selina Tyson.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Alize TilleryTELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4