340317948-1-14-2020-03-CC-TWAN-BKTUKC-20200114143856

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 340317948
Report Date: 01/14/2020
Date Signed: 01/14/2020 02:39:03 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:	ETHEL PHILLIPS PRESCHOOL		FACILITY NUMBER:	340317948
ADMINISTRATOR:	PALMER/POWELL		FACILITY TYPE:	850
ADDRESS:	2930 21ST AVENUE		TELEPHONE:	(916) 277-6780
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95820
CAPACITY:	50	CENSUS: 33	DATE:	01/14/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:50 PM
MET WITH:	Mary Adamis- Veirs		TIME COMPLETED:	03:00 PM

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Licensing Program Analysts (LPAs) Tanya Washington and Rosie Pitts met with Substitute Site Supervisor Mary Adamis-Veirs for the purpose of an unannounced annual random inspection. Site Supervisor was reminded never to exceed the conditions, limitations, and capacity specified on the license. LPAs observed care and supervision of 33 children being supervised by 5 staff. Facility hours of operation are Monday through Thursday from 8:00 AM to 2:30 PM and Friday's from 8 AM to 11 AM. Facility operates on campus of Ethel Phillips Elementary school in classrooms #D7 and #D8.

LPAs toured the classrooms, restroom, and outdoor play area. LPAs reviewed storage of medication and expiration dates. Site Supervisor stated there are no poisons on the premises. Toxic and hazardous items are inaccessible to children. Furniture and equipment are in good condition. Playground equipment and surfaces are free of loose or sharp parts, and is cushioned with adequate substrate to absorb the fall. The toileting facilities are in safe, sanitary, and operating condition. The floors appeared clean throughout the facility.

Storage containers with solid waste have tight-fitting covers. Program provides breakfast, lunch and snack that is delivered to the classroom by the Ethel Phillips Sacramento Unified School District's Cafeteria. Menus were posted and drinking water was readily available to children indoors and outdoors. LPAs observed a sign in and out book with full legal signatures. Staff and children's records were reviewed. Each child's file contained an emergency card and a medical assessment. At least one staff member present today has current Pediatric CPR and First Aid certification (exp. 01/2022).

Report continues on LIC809-C.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya Washington	TELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2020

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: ETHEL PHILLIPS PRESCHOOL	FACILITY NUMBER: 340317948
	VISIT DATE: 01/14/2020

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All staff currently employed with the facility have a criminal record clearance through the school district and documentation of the educational background, training, and/or experience. LPAs reminded Site Supervisor that 100% supervision is required at all times, including in the bathroom. There are no firearms or bodies of water on the premises. LPAs observed a functional carbon monoxide detector. LPAs 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.

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 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.

LPAs discussed and provided the “Effects of Lead Exposure” brochures and advised the Site Supervisor to share the brochures with parents. LPAs provided the following link:http://www.cdss.ca.gov/inforesources/Community-Care-Licensing/subscribe for the Licensee to subscribe to the distribution list and receive Quarterly Updates.

There are no deficiencies cited during today's inspection.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya Washington	TELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2020

LIC809 (FAS) - (06/04)

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