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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340321448
Report Date: 01/20/2023
Date Signed: 01/20/2023 01:39:11 PM


Document Has Been Signed on 01/20/2023 01:39 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:ROBLA PRESCHOOLFACILITY NUMBER:
340321448
ADMINISTRATOR:CHRISTIE ERHRATFACILITY TYPE:
850
ADDRESS:4351 PINELL STREETTELEPHONE:
(916) 927-0136
CITY:SACRAMENTOSTATE: CAZIP CODE:
95838
CAPACITY:198CENSUS: 94DATE:
01/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Janine AlyseTIME COMPLETED:
02:00 PM
NARRATIVE
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On January 20, 2023, Licensing Program Analyst (LPA) Alize Tillery met with Director Janine Alyse for the purpose of an unannounced required 1 year annual inspection. Program is licensed to operate out of rooms 1 through 13. Upon arrival LPA observed 94 preschool children supervised by 18 staff. The facility hours of operation are Monday through Friday from 7:30 AM to 5:30 PM. The facility does not offer transportation services.

LPA toured all activity and classroom spaces (Rooms 1 through 13), restrooms and outdoor play area. LPA observed the following documents are posted: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster and daily schedule. Cleaning disinfectants, medications and hazardous items are appropriately stored and inaccessible to children. Director stated there are poisons or firearms on the premises. Furniture and equipment are in good condition, and toileting facilities are in safe, sanitary and operating condition, and the floors appeared to be clean throughout the facility. LPA observed a functional carbon monoxide detector, smoke detector and fire extinguisher. LPA discussed COVID19 guidelines. Director stated that the program has completed the required Lead Testing.



The program provides breakfast, lunch and two snacks. LPA observed trash bins with tight fitted lids. Drinking water is readily available to children both indoors and outdoors. Director stated that they use disposable cups and their filtered water jugs. LPA observed the facility’s sign in and out sheets in each classroom. Facility has record of conducting fire drills at least every six months; last fire drill was conducted on 1/6/2023. Playground equipment and surfaces are free of loose or sharp parts. There are sufficient equipment and toys, and there are shaded areas supplied by the building and trees, and there is bark under the play equipment for cushioning.

Report continues on 809-C.

SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Alize TilleryTELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:
DATE: 01/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/20/2023
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 01/20/2023 01:39 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: ROBLA PRESCHOOL
FACILITY NUMBER: 340321448

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/20/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101217(a)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above in that Staff Personnel files were incomplete, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/10/2023
Plan of Correction
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LPA will return to review files.
Type B
Section Cited
CCR
101212(b)
Reporting Requirements
(b) The name of the child care center director, and any fully qualified teacher(s) designated to act in the child care center director's absence, shall be reported to the Department within 10 days of a change of child care center director or designee(s).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in that the program did not notify licensing of the Director change, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/27/2023
Plan of Correction
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Director will submit a complete Director packet to LPA Tillery.
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: 01/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/20/2023
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: ROBLA PRESCHOOL
FACILITY NUMBER: 340321448
VISIT DATE: 01/20/2023
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6 staff and 5 children records were reviewed. Staff files were observed to be incomplete and did not include all of the following: Education Verification, LIC 501 Personnel Record, LIC 503 Health Screenings, LIC 508 Criminal Record Statements, LIC 9052 Employee Rights, Immunizations (Tdap, MMR, Influenza) and current Mandated Reporter training certificates. At least one staff member present today has a current Pediatric CPR and First Aid certification that expires in 11/2023.

Children Files were observed to be complete and included: Admission Agreements, Physician and Parent Health History Reports, Emergency Cards, Consent for Medical Treatment forms, Personal and Parent Rights Forms, and immunizations. LPA reminded Director what is to be included on the Children’s Roster. LPA reminded Director that 100% supervision is required at all times. LPA reviewed the Department's inspection authority. Upon arrival LPA was notified that there was a change in the Director position, LPA 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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.


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 is 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



Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Deficiencies are cited on the following 809D page.

A notice of site visit was given and must remain posted for 30 days. An exit interview was conducted and the report was reviewed with the Director, Janine Alyse.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Alize TilleryTELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:

DATE: 01/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023
LIC809 (FAS) - (06/04)
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