<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340321500
Report Date: 09/04/2019
Date Signed: 09/05/2019 09:30:06 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:DAVID REESE ELEMENTARYFACILITY NUMBER:
340321500
ADMINISTRATOR:PINKERTON, ELIZABETHFACILITY TYPE:
850
ADDRESS:7600 LINDALE DRIVETELEPHONE:
(916) 422-2450
CITY:SACRAMENTOSTATE: CAZIP CODE:
95828
CAPACITY:72CENSUS: 14DATE:
09/04/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Thuyet TranTIME COMPLETED:
09:45 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) Christopher Bello met with Head Teacher, Thuyet Tran, regarding an Unusual Incident that took place on August 19, 2019. LPA interviewed Thuyet regarding the incident.

LPA inspected the area that the incident occurred and interviewed the teacher that was present during the incident. Interviews revealed that a child was left on the playground without adult supervision for approximately three to four minutes due to a head count error prior to entering the classrooms. Thuyet stated that the staff had a meeting regarding the incident to prevent future incidents. LPA left a copy of the regulation 101229(a)(1). LPA advised Thuyet regarding Unusual Incidents and the Reporting Requirements that the facility must follow, LPA left a copy of the regulation 101212(d)(1)(c) for the facility.

Title 22 Deficiencies have been cited on the attached LIC 809D. Upon receipt of Type A citations, facility shall post and provide copies of the LIC 809D 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 809D in each child's files
This report was reviewed and discussed with licensee. A notice of site visit and appeal rights were provided.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Christopher BelloTELEPHONE: (916) 862-0844
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2019
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
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: DAVID REESE ELEMENTARY
FACILITY NUMBER: 340321500
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/04/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/04/2019
Section Cited

1
2
3
4
5
6
7
No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This was not met by evidence: Staff left a child outside in the playground alone without adult supervision
8
9
10
11
12
13
14
due to a headcounting error for approximately three to four minutes. This is considered a immediate risk 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: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Christopher BelloTELEPHONE: (916) 862-0844
LICENSING EVALUATOR SIGNATURE:
DATE: 09/04/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/04/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2