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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340312651
Report Date: 10/07/2022
Date Signed: 10/07/2022 04:29:47 PM


Document Has Been Signed on 10/07/2022 04:29 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 CARE - INFANTSFACILITY NUMBER:
340312651
ADMINISTRATOR:WONG, MARIBELLEFACILITY TYPE:
830
ADDRESS:901 P STREET, SUITE 155BTELEPHONE:
(916) 448-5231
CITY:SACRAMENTOSTATE: CAZIP CODE:
95814
CAPACITY:12CENSUS: 11DATE:
10/07/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Maribelle WongTIME COMPLETED:
04:00 PM
NARRATIVE
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On 10/7/2022, at approximately 8:45 AM, Licensing Program Analyst (LPA) Alize Tillery and Licensing Program Manager (LPM) Seychelle De Luca, conduct a case management inspection. Upon arrival, LPA and LPM observed 11 infant children, supervised by 6 staff.

During todays visit, LPA and LPM reviewed staff files. Staff files were observed to be incomplete. LPA reviewed with Director what is to be maintained in personnel files.

Deficiency is listed on the following 809D page.

LPA reviewed the report with licensee, provided appeal rights, as well as the 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: 10/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/07/2022
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 2


Document Has Been Signed on 10/07/2022 04:29 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 - INFANTS
FACILITY NUMBER: 340312651

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/07/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/14/2022
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 3 staff personnel files and all files were observed to be incomplete.
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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: 10/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/07/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2