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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343601817
Report Date: 03/09/2022
Date Signed: 03/09/2022 10:31:18 AM


Document Has Been Signed on 03/09/2022 10:31 AM - 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:CASTORI STATE PRESCHOOLFACILITY NUMBER:
343601817
ADMINISTRATOR:CHOW XIONGFACILITY TYPE:
850
ADDRESS:1801 SOUTH AVETELEPHONE:
(916) 566-3420
CITY:SACRAMENTOSTATE: CAZIP CODE:
95838
CAPACITY:45CENSUS: 13DATE:
03/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Marla MurphyTIME COMPLETED:
10:45 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
On March 9, 2022, at approximately 8:00 AM, Licensing Program Analyst (LPA) Alize Tillery met with Lead Teacher Marla Murphy for the purpose of an unannounced required 1 year annual inspection. Upon arrival, LPA observed 13 children outdoors, supervised by 6 staff. At approximately 9:00 AM, Teacher on Special Assignment (TOSA), Lena Saunders, arrived to assist LPA Tillery. The facility’s hours of operation are Monday through Friday from 8:00 AM to 11:00 AM and 12:00 PM to 3:00 PM. The facility operates in Rooms 30 and 31 on the campus of Michael J. Castori Elementary School. The facility does not offer transportation services.

LPA toured all activity and classroom spaces, kitchen, restrooms and outdoor play area. LPA observed children two years and above to be wearing masks while indoors. LPA discussed current COVID19 mandates and guidelines with TOSA. 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. TOSA stated there are no 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. The elementary school provides lunch and one snack.



LPA observed trash bins with tight fitted lids. Drinking water is readily available to children both indoors and outdoors. Lead Teacher stated that there is a water pitcher that is used and disposable cups are accessible to children. LPA observed the facility’s electronic sign in and out system. Facility has record of conducting fire drills at least every six months; last fire drill was conducted on 2/10/2022. 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. LPA reminded TOSA to have staff scan the outdoor play area for any trash that might've blown in from the strong winds.

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: 03/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/09/2022
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 3


Document Has Been Signed on 03/09/2022 10:31 AM - 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: CASTORI STATE PRESCHOOL
FACILITY NUMBER: 343601817

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/09/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101221(b)(8)(C)
Child's Records
(C) A signed consent form for emergency medical treatment unless the child's authorized
representative has signed the statement specified in Section 101220(f).

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and record review, the licensee did not comply with the section cited above in that the children's files did not contain the LIC 627 form, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/30/2022
Plan of Correction
1
2
3
4
LPA will return to review children 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
1
2
3
4
Based on observation, interview and record review, the licensee did not comply with the section cited above in that the department was not notified of a change in director, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/30/2022
Plan of Correction
1
2
3
4
TOSA is to submit documents listed on the Director Checklist, 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: 03/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/09/2022
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: CASTORI STATE PRESCHOOL
FACILITY NUMBER: 343601817
VISIT DATE: 03/09/2022
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
26
27
28
29
30
31
32
During staff interview, LPA was made aware that previous Director, Chow Xiong, is no longer with the facility. The department was not notified of this change. TOSA was provided with the change of director checklist. 3 staff and 7 children's records were reviewed. Staff files were observed to be complete. At least one staff member present today has a current Pediatric CPR and First Aid certification that expires on 5/26/2023. Children’s files were observed to be incomplete and missing an admission agreement, LIC 627 Consent for Medical Treatment form and Parents Rights form. LPA provided a checklist to TOSA of documents to be kept in children’s files. LPA reminded TOSA that 100% supervision is required at all times. LPA observed a functional carbon monoxide detector, smoke detector and fire extinguisher. LPA 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.

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



TOSA 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.

Exit interview conducted and report was reviewed with the TOSA, Lina Saunders.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Alize TilleryTELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3