343605276-3-9-2022-03-CC-ATIY-CCCRZN-20220309122814

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343605276
Report Date: 03/09/2022
Date Signed: 03/09/2022 12:28:22 PM

Document Has Been Signed on 03/09/2022 12:28 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:	BABCOCK STATE PRESCHOOL		FACILITY NUMBER:	343605276
ADMINISTRATOR:	PRISCILLA CONTRERAS		FACILITY TYPE:	850
ADDRESS:	2400 CORMORANT WAY		TELEPHONE:	(916) 566-3415
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95815
CAPACITY:	24	CENSUS: 9	DATE:	03/09/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Priscilla Contreras		TIME COMPLETED:	12:45 PM

NARRATIVE

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On March 9, 2022, at approximately 11:00 AM, Licensing Program Analyst (LPA) Alize Tillery met with Director Priscilla Contreras for the purpose of an unannounced required 1 year annual inspection. Upon arrival, LPA observed 9 children supervised by 2 staff and 1 parent. At approximately 11:45, Teacher on Special Assignment (TOSA), Lena Saunders, arrived to assist LPA Tillery. The facility hours of operation are Monday through Friday from 7:00 AM to 5:00 PM. The facility operates on the Babcock Elementary school campus in rooms 42 and 43. The facility does not offer transportation services.

LPA toured all activity and classroom spaces (Rooms 42 and 43), 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 Director. 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 program provides breakfast, lunch and supper.

LPA observed trash bins with tight fitted lids. Drinking water is readily available to children both indoors and outdoors. Director 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 2/11/2022. 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

Report continues on 809-C.

SUPERVISOR'S NAME: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Alize Tillery	TELEPHONE: (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)

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Document Has Been Signed on 03/09/2022 12:28 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: BABCOCK STATE PRESCHOOL	FACILITY NUMBER: 343605276
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/09/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101221(b)(6)

Child's Records

(b) Each record shall contain information including, but not limited to, the following: (6) A signed copy of the admission agreement specified in Section 101219. 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 childrens files do not have admission agreements on file, 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 or director will email the admission agreement to LPA TIllery.

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: Alize Tillery	TELEPHONE: (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)

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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: BABCOCK STATE PRESCHOOL	FACILITY NUMBER: 343605276
	VISIT DATE: 03/09/2022

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2 staff and 5 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 6/2/2023. Children’s files were observed to be missing admission agreements and the LIC 995 parent rights form. TOSA was provided with a checklist that covers all documents to be placed in the children’s files. LPA reminded TOSA to keep a current Children’s Roster on file, that is to be maintained for three years. LPA reminded Licensees 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, Lena Saunders.

SUPERVISOR'S NAME: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Alize Tillery	TELEPHONE: (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)

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