340318374-1-17-2020-03-CC-JHOA-BKWR8V-20200117114833

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 340318374
Report Date: 01/17/2020
Date Signed: 01/17/2020 11:48:38 AM

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:	CORDOVA VILLA ELEMENTARY SCHOOL		FACILITY NUMBER:	340318374
ADMINISTRATOR:	LOR, GEE		FACILITY TYPE:	850
ADDRESS:	10460 REYMOUTH AVENUE		TELEPHONE:	(916) 366-6181
CITY:	RANCHO CORDOVA	STATE: CA	ZIP CODE:	95670
CAPACITY:	22	CENSUS: 17	DATE:	01/17/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Aundria Perez		TIME COMPLETED:	12:10 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), Jan Hoshida, conducted an unannounced random annual inspection today. LPA met with Site Supervisor, Aundria Perez. A tour of the facility was conducted inside and outside. Upon arrival, LPA observed 17 children supervised by three staff members. The following areas are in compliance during the visit. There are no bodies of water. Firearms and ammunition are not on the premises. Site Supervisor stated that there were no poisons present on site. Disinfectants, hazardous items and medications are inaccessible to children. Furniture and equipment are sufficient, age appropriate and in good repair. Fire drills are conducted and documented. Carbon Monoxide detectors were present. The playground equipment and outdoor activity space is maintained and in good condition. Wood chips are being used as cushioning around the climbing equipment and level is sufficient to absorb a fall. Children's toilets, hand washing facilities are sanitary. Floors are clean and free of debris. Drinking water is available inside. LPA observed that the drinking fountain outside was not working properly. Site Supervisor stated that she will put in a work order to fix that as soon as possible and will bring water and cups for the children to use. Menus are posted. The facility is in compliance with conditions and limitations specified on the license. Sign in/sign out sheets are maintained. No excluded individuals are present. First Aid/CPR reviewed and in compliance. Emergency information reviewed for some children. Some staff records were reviewed. The center is open Mondays through Fridays during the academic school year and conducts a morning class from 8:00am to 11:00am and an afternoon class from 11:45am to 2:45pm and the children do not take naps. The center provides lunch and breakfast through the food services provided by Folsom Cordova Unified School District. Site Supervisor stated that no food is kept within the classroom. *REPORT CONTINUED ON NEXT PAGE*

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Jan Hoshida	TELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2020

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: CORDOVA VILLA ELEMENTARY SCHOOL	FACILITY NUMBER: 340318374
	VISIT DATE: 01/17/2020

NARRATIVE

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All staff present had evidence of current criminal background clearances and/or associations through the Folsom Cordova Unified School District.

This facility provides Incidental Medical Services- IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing 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.

LPA discussed the Mandated Reporter Training with Site Supervisor. Beginning January 1, 2018, Health and Safety Code 1596.8662 requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. In addition, existing staff must meet requirements by March 30, 2018. This training requirement may be met by using the Department’s Office of Child Abuse Prevention (OCAP) online training modules. The OCAP modules are free of cost and available at: http://www.mandatedreporterca.com/. The training is currently provided in English.

LPA provided the Community Care Licensing’s website www.ccld.ca.gov, so the Site Supervisor can obtain updated licensing information, new regulations and access forms. LPA advised Site Supervisor of their responsibility to stay current in regards to new regulations. LPA also included the email address for the children's advocacy program to stay current on new laws childcareadvocatesprogram@dss.ca.gov.

No Title 22 Deficiencies observed in the areas that were evaluated. LPA reviewed report with the Site Supervisor and provided copies. An exit interview was conducted. LPA observed the Notice of Site Visit posted and the Site Supervisor understands it must remain posted for 30 days.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Jan Hoshida	TELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2020

LIC809 (FAS) - (06/04)

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