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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343604900
Report Date: 11/01/2022
Date Signed: 11/01/2022 04:10:32 PM


Document Has Been Signed on 11/01/2022 04:10 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:4TH R - PHOEBE HEARSTFACILITY NUMBER:
343604900
ADMINISTRATOR:NOLLER, CHRISTINEFACILITY TYPE:
840
ADDRESS:1410 60TH STREETTELEPHONE:
(916) 277-3840
CITY:SACRAMENTOSTATE: CAZIP CODE:
95819
CAPACITY:200CENSUS: 114DATE:
11/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Hilary CobbsTIME COMPLETED:
04:30 PM
NARRATIVE
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On Friday, September 22, 2022 at 9:00 am, Licensing Program Analysts (LPA) Amanda Sutter and Soleil Marx met Director Hilary Cobb for the purpose of an unannounced required annual inspection. LPAs observed 114 children supervised by 10 staff and one volunteer. All individuals subject to criminal background review have obtained a criminal record clearance. Facility is licensed to operate in classrooms 1, 3, 26, 23, the Multipurpose Room, and the 4th R classroom. Currently the center operates in classroom1, the multipurpose room, and the 4th R classroom. The facility hours of operation are Monday through Thursday from 7:30 AM to 5:30 PM

LPAs toured classroom spaces and outdoor play area. LPAs observed the following documents are posted: License, Emergency Disaster Plan, menu, and seat belt law. LPAs observed a functional carbon monoxide detector. LPAs discussed proper storage of cleaning disinfectants, medications and hazardous items. Director 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. The program provides one snack.

LPAs observed trash bins with tight fitted lids. LPAs 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 October 11, 2022. The facility uses the blacktop area for outdoor play. Shaded areas are supplied by the building and trees. Drinking water is readily available to children both indoors and outdoors. Director stated that children bring their own water bottles and are refilled at the facility.

Six staff and five children's records were reviewed. Both children and staff files were observed to be complete. There is at least one staff member present with a current CPR certificate. PAGE 1. REPORT CONTINUES ON LIC809-C

SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Amanda SutterTELEPHONE: (916) 261-8918
LICENSING EVALUATOR SIGNATURE:
DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2022
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: 4TH R - PHOEBE HEARST
FACILITY NUMBER: 343604900
VISIT DATE: 11/01/2022
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LPA discussed the safe sleep regulations with director 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. LPAS also informed director 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.

Incidental Medical Service (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 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

Director 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.

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.

During today’s inspection, one type B deficiencies was observed. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Director Hilary Cobb.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Amanda SutterTELEPHONE: (916) 261-8918
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 11/01/2022 04:10 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: 4TH R - PHOEBE HEARST

FACILITY NUMBER: 343604900

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 11/01/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 3 out of 6 files reviewed which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/18/2022
Plan of Correction
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Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Amanda SutterTELEPHONE: (916) 261-8918
LICENSING EVALUATOR SIGNATURE:
DATE: 11/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2022
LIC809 (FAS) - (06/04)
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