340306212-9-25-2019-03-CC-KGOL-BGCQL7-20190925121528

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 340306212
Report Date: 09/25/2019
Date Signed: 09/25/2019 12:15:38 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:	DOT TOT CENTER FOR INFANTS		FACILITY NUMBER:	340306212
ADMINISTRATOR:	GINA QUERAL		FACILITY TYPE:	830
ADDRESS:	1630 12TH STREET		TELEPHONE:	(916) 442-5421
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95814
CAPACITY:	24	CENSUS: 14	DATE:	09/25/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Gina Queral		TIME COMPLETED:	12:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA), Goodell met with director Gina Queral for an unannounced Annual Inspection. The facility's hours of operation are Monday-Friday, 7am-6pm. During inspection LPA observed 14 children with 5 staff members and director. All individuals present have obtained fingerprint clearance through community care licensing. LPA toured the facility including activity/classroom areas, furniture, equipment, food service area and restrooms. The Director stated that the facility provides breakfast, morning/afternoon snack and lunch. LPA observed a current menu and activity scheduled posted in elmo classroom. Director stated facility recently began using an electronic application to document children's daily routine, meals and activities. LPA observed cleaning compounds inaccessible to children. Director stated that there are no firearms, poisons, or bodies of water on the property. LPA observed that the changing tables are located near a sink. LPA observed the outdoor area and play equipment. LPA observed the infant outdoor play toys have been not been maintained due to sun damage and accumulated dust and dirt. Director acknowledged that furniture shall be maintained in good repair and safe condition. LPA also learned that equipment is cleaned every six months. LPA observed fire extinguisher 3A40BC, smoke detector and carbon monoxide. LPA reviewed children files; documents included Identification and Emergency information and the Infant’s Needs and Services plan. LPA observed infant bottles are labeled and dated. Director stated all milk and food brought from home are returned daily. LPA observed children roster. Report continues on LIC 809-C

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kristal Goodell	TELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2019

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: DOT TOT CENTER FOR INFANTS	FACILITY NUMBER: 340306212
	VISIT DATE: 09/25/2019

NARRATIVE

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LPA observed the infant napping equipment. The director acknowledged that the nap area is separate from the activity area and direct supervision is required in that room. LPA reviewed staff files and educational requirements, including the Infant course. LPA observed that at least one staff member present during today’s inspection has current Pediatric CPR/First Aid that expires 8/30/21.

LPA provided the Community Care Licensing website www.ccld.ca.gov, so the director can obtain updated licensing information, new regulations, self-assessment guides and access forms. LPA advised the director of their responsibility to stay current with new regulations.

Title 22 Deficiency cited on LIC 809-D. LPA reviewed report with the director and provided copy of print of the (LIC809). Print out of Notice of Site Visit (LIC9213) was also provided and must remain posted for 30 days.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kristal Goodell	TELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2019

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: DOT TOT CENTER FOR INFANTS	FACILITY NUMBER: 340306212
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/25/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/25/2019 Section Cited	1 2 3 4 5 6 7	Infant Care Center Fixtures, Furniture, Equipment and Supplies. Furniture shall be maintained in good repair and safe condition. This requirement is not met due to LPA observed infant outdoor play toys have not been maintained due to sun damage and accumulated dust and dirt. LPA also learned that equipment is cleaned every six months.
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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 Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kristal Goodell	TELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2019

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2019

LIC809 (FAS) - (06/04)

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