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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340305706
Report Date: 01/13/2023
Date Signed: 01/13/2023 02:27:56 PM


Document Has Been Signed on 01/13/2023 02:27 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: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: 12DATE:
01/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Selina TysonTIME COMPLETED:
02:45 PM
NARRATIVE
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On January 13, 2023, at approximately 12:30 PM, Licensing Program Analyst (LPA) Alize Tillery met with Director Selina Tyson for the purpose of an unannounced required 1 year annual inspection. Upon arrival, LPA observed 2 awake infant children, supervised by 2 staff; and 8 napping children, supervised by 1 staff. The facility hours of operation are Monday through Friday from 7:00 AM to 6:00 PM. The facility does not offer transportation services.

LPA toured all activity and classroom spaces (babies and toddlers room), napping area, kitchen, restrooms and outdoor play area. Program is documenting napping infants, every 15 minutes. LPA informed Director that policy is considering whether sleep sacks/suits will be allowed in child care centers. LPA recommended Director keep an eye out for any licensing informational notices. LPA observed the following documents are posted: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster and daily schedule. Cleaning disinfectants medications and hazardous items are appropriately stored and inaccessible to children. Director stated there are no poisons or firearms on the premises. Furniture and equipment are in good condition, and toileting facilities are in safe, sanitary and operating condition, and the floors appeared to be clean throughout the facility. LPA observed two changing tables in arms reach of a sink. LPA observed infant food and bottles in the refrigerator with the child’s name but without a date. LPA observed a functional carbon monoxide detector, smoke detector and fire extinguisher. LPA discussed COVID19 guidelines. Director stated that the program has completed the required Lead Testing.



The program provides breakfast, lunch and 2 snacks. LPA observed trash bins with tight fitted lids. Drinking water is readily available to children both indoors and outdoors. Director stated that they use a water jug and provide cups for the children. LPA observed the facility’s sign in and out system. Facility has record of conducting fire drills at least every six months. Playground equipment and surfaces are free of loose or sharp parts. There are sufficient equipment and toys, and there are shaded areas supplied by the buildings.
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: 01/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/13/2023
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 01/13/2023 02:27 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
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: 01/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101427(j)
Infant Care Food Service
(j) Bottles, dishes and containers of food brought by the infant's authorized representative shall be labeled with the infant's name and the current date.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in that childrens milk bottles were not dated, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/20/2023
Plan of Correction
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Licensee will review infant food and bottle service regulations, and submit a correspondence to LPA confirming her review.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Alize TilleryTELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:
DATE: 01/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/13/2023
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: FOREVER YOUNG INFANT CARE CENTER
FACILITY NUMBER: 340305706
VISIT DATE: 01/13/2023
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5 staff and 5 children records were reviewed. Staff files were observed to be complete and included: Education Verification, LIC 501 Personnel Record, LIC 503 Health Screenings, LIC 508 Criminal Record Statements, LIC 9052 Employee Rights, Immunizations (Tdap, MMR, Influenza) and current Mandated Reporter training certificates. At least one staff member present today has a current Pediatric CPR and First Aid certification that expires in 02/2024.

Children Files were also observed to be complete and included: Admission Agreements, Physician and Parent Health History Reports, Emergency Cards, Consent for Medical Treatment forms, Personal and Parent Rights Forms, and immunizations. LPA observed a current Children’s Roster. LPA reminded Licensees that 100% supervision is required at all times. 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.

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.


Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA is 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



Director 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.

A deficiency is cited on the following 809D page.

A notice of site visit was given and must remain posted for 30 days. An exit interview was conducted and the 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: 01/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2023
LIC809 (FAS) - (06/04)
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