343603166-10-23-2019-53-CC-ASIA-BH8SEW-20191023134925

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343603166
Report Date: 10/23/2019
Date Signed: 10/23/2019 01:49:30 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:	ELK GROVE SCHOOL AGE CDC		FACILITY NUMBER:	343603166
ADMINISTRATOR:	EDWARDS, DORIS		FACILITY TYPE:	840
ADDRESS:	9373 CROWELL DRIVE		TELEPHONE:	(916) 686-6495
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95624
CAPACITY:	70	CENSUS: 8	DATE:	10/23/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:50 PM
MET WITH:	Site Supervisor- Amber Llacuna		TIME COMPLETED:	02:10 PM

NARRATIVE

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Licensing Program Analysts (LPAs) Amy Silva and Seychelle De Luca met with Site Supervisor Amber Llacuna for the purpose of an unannounced annual random inspection. Upon arrival, LPAs observed eight school-age children supervised by one staff member. Facility hours of operation are Monday through Friday from 7:00 AM to 6:00 PM.

LPAs toured all activity and classroom spaces, restrooms, kitchen, and outdoor play areas. Site Supervisors stated there are no poisons on the premises. Medications, and toxic and hazardous items are inaccessible to children. Furniture and equipment are in good condition. Playground equipment and surfaces are free of loose or sharp parts. The areas around or under climbing equipment are cushioned with bark to absorb the fall. Toileting facilities are in safe, sanitary, and operating condition. The floors appeared clean throughout the facility. The kitchen is free of litter and all food was protected against contamination. Storage containers with solid waste have tight-fitting covers. Program provides breakfast, lunch and afternoon snack. Menus were posted and drinking water was readily available to children both indoors and outdoors. LPAs observed full legal signatures while reviewing the sign-in and sign-out sheets.

Three staff and three children's records were reviewed. Each child's file contained an emergency card and a medical assessment. At least one staff member present today has current Pediatric CPR and First Aid certification (exp. 9/2020). All staff currently employed with the facility have a criminal record clearance, health screening report, mandated reporter certificates, and documentation of the educational background, training, and/or experience.

Report continues on 809-C.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Amy Silva	TELEPHONE: (916) 926-9100
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2019

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: ELK GROVE SCHOOL AGE CDC	FACILITY NUMBER: 343603166
	VISIT DATE: 10/23/2019

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There are no firearms or bodies of water on the premises. LPAs reviewed the Department's inspection authority and discussed with Site Supervisor any changes that may occur regarding the Site Supervisor or an employee acting in the Site Supervisor's absence must be reported to department within ten working days.

The facility's Plan of Operation is located in the facility file. Incidental Medical Services (IMS) policy was discussed. IMS is provided by this facility. 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.

LPAs provided and discussed Effects of Lead Exposure brochure.

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 athttp://www.ada.gov/childqanda.htm.

This facility evaluation report was reviewed and discussed with Sit Supervisor. A Notice of Site Visit was provided and should remain posted for a period of 30 days for parental review. Site Supervisor was encouraged to the visit the departments website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining child care centers. In the areas that were evaluated, no deficiencies were observed at the time of the visit.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Amy Silva	TELEPHONE: (916) 926-9100
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2019

LIC809 (FAS) - (06/04)

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