340318380-1-23-2020-03-CC-JHOA-BL4PPZ-20200123103021

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 340318380
Report Date: 01/23/2020
Date Signed: 01/23/2020 10:30:31 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:	PETER J. SHIELDS ELEMENTARY SCHOOL		FACILITY NUMBER:	340318380
ADMINISTRATOR:	RACELES, GRAZIELLA BON		FACILITY TYPE:	850
ADDRESS:	10434 GEORGETOWN DRIVE		TELEPHONE:	(916) 635-5416
CITY:	RANCHO CORDOVA	STATE: CA	ZIP CODE:	95670
CAPACITY:	24	CENSUS: 17	DATE:	01/23/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:10 AM
MET WITH:	Giraziella Raceles		TIME COMPLETED:	11:00 AM

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 Lead Teacher, Giraziella Raceles. 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. Furniture and equipment are sufficient, age appropriate and in good repair. 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 outside. 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 the children do not take naps. The center provides breakfast through the food services provided by Folsom Cordova Unified School District. All staff present had evidence of current criminal background clearances and/or associations through the Folsom Cordova Unified School District. LPA observed Clorox wipes on the classroom table and observed ant killer on the window sill and under the sink cabinet that were accessible to the children in care. Teacher stated that she knows that the Clorox wipes should be inaccessible to children and that the maintenance department placed the ant bait within the classroom around Winter Break. Teacher moved the Clorox wipes and ant killer to a locked cabinet that is inaccessible to the children in care. *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: 01/23/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2020

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: PETER J. SHIELDS ELEMENTARY SCHOOL	FACILITY NUMBER: 340318380
	VISIT DATE: 01/23/2020

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. 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 new Mandated Reporter Training with Lead Teacher. 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 Lead Teacher can obtain updated licensing information, new regulations and access forms. LPA advised Lead Teacher 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.

Title 22 deficiency has been cited on the attached LIC 809-D. Upon receipt of Type A citations, facility shall post and provide copies of the LIC 809-D for parents/guardians of children currently in care and for parents/guardians of newly enrolled children for the next 12 months. Facility must also keep the signed LIC 9224, Acknowledging Receipt of Licensing Reports LIC 809-D in each child's files

This report was reviewed and discussed with Lead Teacher. A Notice of Site Visit and appeal rights were provided.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Jan Hoshida	TELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2020

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: PETER J. SHIELDS ELEMENTARY SCHOOL	FACILITY NUMBER: 340318380
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/23/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 01/24/2020 Section Cited	1 2 3 4 5 6 7	Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: LPA observed Clorox wipes on the classroom table and observed ant killer on the window sill and under the sink that were accessible to the children in care.	8 9 10 11 12 13 14
	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: Jan Hoshida	TELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2020

LIC809 (FAS) - (06/04)

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