343604409-3-2-2023-03-CC-KGUA-CPJVD4-20230302152007

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343604409
Report Date: 03/02/2023
Date Signed: 03/02/2023 03:20:19 PM

Document Has Been Signed on 03/02/2023 03:20 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:	SAN JUAN EARLY HEAD START		FACILITY NUMBER:	343604409
ADMINISTRATOR:	DEBRA MCMANNIS		FACILITY TYPE:	830
ADDRESS:	7551 GREENBACK LANE		TELEPHONE:	(916) 728-3109
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95610
CAPACITY:	42	CENSUS: 11	DATE:	03/02/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Angelica Dennis and Meghan Jorgensen		TIME COMPLETED:	03:30 PM

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At 12:30 p.m. on Thursday, March 2nd, 2023, Licensing Program Analyst (LPA) Karyn Guerra met with TOSA, Angelica Dennis and Administrator, Meghan Jorgensen, for the purpose of an unannounced, required - 1 year inspection. Upon arrival, LPA observed a census of 4 infants supervised by 1 staff, and 7 toddlers supervised by 2 staff. 1 additional staff member was in the office area on their break. Hours of operation are from 8:00 a.m. – 3:00 p.m., Monday thru Friday.

At 12:35 p.m., during census count, LPA observed a napping infant (C1) in a crib with a blanket. Blanket was partially covering face of infant. LPA notified Staff (S1) who immediately removed blanket from crib.

Criminal record clearances are on file with the District office. TOSA and Administrator were 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.

LPA conducted a health and safety inspection of the classroom, restrooms, and food service areas. LPA observed the following documents are posted: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, car seat laws, menus, and daily schedule. Cleaning disinfectants and hazardous items are appropriately stored and inaccessible to children. Administrator stated that there are no firearms nor poisons on the premises. LPA observed a changing table within arm's reach of a sink. Changing table has raised sides and a padded base. Bins for solid waste have tight fitting lids. The floors appeared clean throughout the facility. The facility provides formula, breakfast, and lunch. LPA observed prepared milk bottles labeled with children's names and the current date. Other food in the facility was properly stored to prevent contamination. Drinking water is provided to children via pitcher and cups. LPA reminded TOSA and Administrator that drinking and cooking water shall be tested for lead per AB2370. LPA observed sign in and sign out logs with full legal signature of parent/guardians.

Report continued on 809-C.

SUPERVISOR'S NAME: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Karyn Guerra	TELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:	DATE: 03/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023

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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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: SAN JUAN EARLY HEAD START	FACILITY NUMBER: 343604409
	VISIT DATE: 03/02/2023

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No children in care require medications. Incidental Medical Services – IMS was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

LPA conducted a health and safety inspection of the outdoor space. Playground equipment and surfaces were free of loose or sharp parts. LPA observed wood chips to provide cushioning. Outdoor shade was provided by trees. Water is accessible via pitcher and cups.

LPA reviewed staff and children's records. Each child's file contained an admission agreement, emergency card, health history, immunizations, and acknowledgement of receipt of personal rights, consent for emergency medical treatment, and parent’s rights. LPA observed updated needs and services plans, napping logs, and individual infant sleeping plans. LPA observed CPR and First aid certification for at least one staff on the facility premises. LPA observed health screening, staff immunization records, current AB 1207 Mandated Reporter training certificates, employee rights, and documentation of the educational background, training, and/or experience.

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.

report continued on 809-C.

SUPERVISOR'S NAME: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Karyn Guerra	TELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:	DATE: 03/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023

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: SAN JUAN EARLY HEAD START	FACILITY NUMBER: 343604409
	VISIT DATE: 03/02/2023

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Title 22 deficiencies are cited on the subsequent pages of this report. Administrator acknowledges, that FOR TYPE A DEFICIENCIES ONLY upon receipt, licensee shall post LIC 9099D with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the licensee. LIC 9224 and Appeal Rights were provided. Administrator's signature on this report acknowledges receipt of these rights. This report was reviewed with Administrator, Meghan Jorgensen. An exit interview was conducted. A Notice of Site Visit was provided and shall remain posted for a period of 30 days.

SUPERVISOR'S NAME: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Karyn Guerra	TELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:	DATE: 03/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023

LIC809 (FAS) - (06/04)

Page: 3 of 5

Document Has Been Signed on 03/02/2023 03:20 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: SAN JUAN EARLY HEAD START	FACILITY NUMBER: 343604409
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/02/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

101439.1(f)

Infant Care Center Sleeping Equipment

(f) Cribs shall be free from all loose articles and objects, including blankets and pillows. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above as child 1 (C1) was observed sleeping in a crib with a blanket. Blanket was partially covering head of C1. This poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 03/03/2023
	Plan of Correction
1 2 3 4	LPA alerted Staff 1 (S1) who immediately removed blanket from crib. A staff meeting was conducted during inspection while LPA reviewed report with Administrator during which safe sleep practices were reviewed. POC cleared during inspection.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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 Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Karyn Guerra	TELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:	DATE: 03/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023

LIC809 (FAS) - (06/04)

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