343605845-8-12-2022-03-CC-KFEA-CH8QUW-20220812122927

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343605845
Report Date: 08/12/2022
Date Signed: 08/12/2022 12:29:35 PM

Document Has Been Signed on 08/12/2022 12:29 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:	THEODORE JUDAH		FACILITY NUMBER:	343605845
ADMINISTRATOR:	BARGER, SABRINA		FACILITY TYPE:	850
ADDRESS:	101 DEAN WAY ROOM #19		TELEPHONE:	(916) 983-4469
CITY:	FOLSOM	STATE: CA	ZIP CODE:	95630
CAPACITY:	30	CENSUS: 23	DATE:	08/12/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Jacqueline Wyse		TIME COMPLETED:	01:00 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	On Friday, August 12th, 2022, Licensing Program Analyst (LPA) Kelly Ferrara met with Facility Representative Jacqueline Wyse for an unannounced annual inspection. The facility is located in room K1 on the Theodore Judah elementary school campus. At 10:30 AM, LPA toured the facility including all activity and classroom spaces, restrooms, food service and outdoor play areas. The facility operates according to the Folsom Cordova School District schedule and has a morning and afternoon program. The morning program operates Monday through Friday 8 am to 11 am and the afternoon program is 11:45 am to 2:45 pm. Census included 23 preschool children in care with four staff in the morning and 14 children with four staff in the afternoon. Facility Representative was reminded never to exceed the conditions, limitations and capacity specified on the license. Facility Representative 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. The classroom appeared clean including the carpets and floor. Chemicals and cleaning materials were kept inaccessible to children. Playground equipment and surfaces were inspected and are in good condition with enough resilient material under climbing structures to absorb a fall. Drinking water was readily available to children both indoors and outdoors in personal water bottles. The bathrooms were clean and all sinks and toilets were in operating condition. There are no firearms or bodies of water on the premises and the facility has at least one functioning smoke and carbon monoxide detector. Menus were posted for AM and PM snack and the children are provided lunches. LPA observed the appropriate postings were visible to parents. LPA observed a current children's roster and LPA advised a fire drill should be conducted with the new group of students. The facility is equipped with First Aid equipment. LPA observed parents are signing their children in and out of the facility.

SUPERVISOR'S NAME: Natalie Dunaway	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Kelly Ferrara	TELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2022

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: THEODORE JUDAH	FACILITY NUMBER: 343605845
	VISIT DATE: 08/12/2022

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At 11 AM, all present staff files were reviewed. LPA reviewed staff transcripts and observed all staff being utilized as teachers were qualified. LPA advised the Mandated Reporter certificates are close to expiration and must be renewed every two years. LPA observed proof of immunizations for the staff and all required documentation was present in the files. At least one staff had a current Pediatric CPR and First Aid certification which expires August 2023. LPA observed a sample of children's files and observed all required documentation was present in each file.

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 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

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/inspection-process.

Facility Representative was encouraged to the visit the Department's website at WWW.CCLD.CA.GOV for information regarding child care updates, PINs, forms, regulations and legislation pertaining to child care centers.

No citations were issued based on today’s inspection. Exit interview was conducted and report was reviewed with the Facility Representative. A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Natalie Dunaway	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Kelly Ferrara	TELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2022

LIC809 (FAS) - (06/04)

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