343602637-10-3-2019-03-CC-CBEO-BGLSAS-20191003134248

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343602637
Report Date: 10/03/2019
Date Signed: 10/03/2019 01:42:56 PM

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:	JACKSON SCHOOL AGE CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	343602637
ADMINISTRATOR:	BRYANT, JANETTE		FACILITY TYPE:	840
ADDRESS:	8351 CUTLER WAY		TELEPHONE:	(916) 689-5274
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95828
CAPACITY:	56	CENSUS: 12	DATE:	10/03/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	Janice Lal		TIME COMPLETED:	02:00 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) Christopher Bello conducted random annual inspection. LPA met with site supervisor Janice Lal. This facility is located on Isabelle Jackson Elementary School grounds in Portable 1 and 2, The facility operates Monday through Friday from 7:00 A.M. to 6:00 P.M. The facility provides breakfast, lunch and dinner for the children. LPA toured the facility including all activity/classroom areas, the isolation area, food service area, restrooms and outdoor play areas. LPA reviewed care and supervision of children, staffing ratios, health related services, furniture, equipment, drinking water and food service provisions. The facility uses the elementary school playground and the elementary school bathrooms. LPA reviewed the children's Identification and Emergency Information. LPA reviewed personnel's education and immunization requirements. All staff currently employed with the center have criminal record clearances and are associated to the Sunset Ranch site facility # 313620604. At least one staff member present today has current EMSA approved Pediatric/Child CPR and First Aid. 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. REPORT CONTINUES ON NEXT PAGE.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Christopher Bello	TELEPHONE: (916) 862-0844
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2019

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: JACKSON SCHOOL AGE CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 343602637
	VISIT DATE: 10/03/2019

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LPA provided the Community Care Licensing’s website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA advised licensee of their responsibility to stay current in regards to new regulations.
LPA observed current mandated reporter training on file at time of inspection.
LPA advised licensee to sign up for the quarterly updates provided by the Childcare Advocates Program. LPA provided the link https://www.cdss.ca.gov/inforesources/Community-Care-Licensing/subscribe for the licensee to sign up for the updates.

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

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Christopher Bello	TELEPHONE: (916) 862-0844
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2019

LIC809 (FAS) - (06/04)

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