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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340309465
Report Date: 09/01/2022
Date Signed: 09/01/2022 03:15:04 PM


Document Has Been Signed on 09/01/2022 03:15 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:RAINBOW DAY CAREFACILITY NUMBER:
340309465
ADMINISTRATOR:WONG, MARIBELLEFACILITY TYPE:
850
ADDRESS:901 P STREET, SUITE 155BTELEPHONE:
(916) 448-5231
CITY:SACRAMENTOSTATE: CAZIP CODE:
95814
CAPACITY:48CENSUS: 16DATE:
09/01/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Maribelle WongTIME COMPLETED:
03:30 PM
NARRATIVE
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On September 1, 2022, at approximately 12:30 PM, Licensing Program Analyst (LPA) Alize Tillery, arrived at the facility to conduct a case management inspection. Director Maribelle Wong assisted LPA throughout today's visit.

During today's inspection, LPA reviewed 3 preschool member personnel files. All files were observed to be incomplete. LPA provided and reviewed with Director the LIC 125 Entrance Checklist and all documents that are too be maintained in staff personnel files. Director stated that she will work on ensuring all required documents are in staff files.

Deficiency is cited on the following 809D page. LPA provided appeal rights and reviewed the report with Director. LPA provided a notice of site visit which is to be posted for 30 days.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Alize TilleryTELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:
DATE: 09/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/01/2022
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 09/01/2022 03:15 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: RAINBOW DAY CARE
FACILITY NUMBER: 340309465

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/01/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/09/2022
Section Cited

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(a) Personnel records shall be maintained on the licensee, administrator, and each employee, and shall contain specified information.

Based on observation and record review, this requirement was not met evidenced by:
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LPA reviewed 5 staff personnel files and all files were observed to be complete.
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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: 09/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/01/2022
LIC809 (FAS) - (06/04)
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