343606947-9-27-2023-03-CC-TWAN-CW3RFF-20230927125900

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343606947
Report Date: 09/27/2023
Date Signed: 09/27/2023 04:38:16 PM

Document Has Been Signed on 09/27/2023 04:38 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	HIRAM JOHNSON CENTER		FACILITY NUMBER:	343606947
ADMINISTRATOR:	SARABA/VANG, YE		FACILITY TYPE:	850
ADDRESS:	3535 65TH STREET		TELEPHONE:	(916) 277-6767
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95820
CAPACITY:	73	CENSUS: 26	DATE:	09/27/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:40 AM
MET WITH:	Dometila Casillas and Suzie Vang		TIME COMPLETED:	01:10 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 Wednesday, September 27, 2023, at 11:40 AM, Licensing Program Analysts (LPAs) Tanya Washington and Lea Habtom met with Facility Representatives Dometila Casillas and Suzie Vang for the purpose of an unannounced required annual inspection. LPA observed care and supervision of 26 children supervised by six staff. The facility hours of operation are Monday through Friday from 8:00 AM to 3:00 PM. The program operates in classrooms #B1 and #B2.

LPAs toured both classrooms, restroom, and outdoor play area. LPAs observed the following documents are posted: License, Emergency Disaster Plan, Earthquake Preparedness, Personal Rights, Parents' Rights Poster, menu, and seat belt law. Cleaning disinfectants, medications and hazardous items are appropriately stored and inaccessible to children. Facility Representative 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 breakfast, lunch, and snack. Food is prepared at Hiram Johnson High School cafeteria and is delivered to classrooms daily.

LPAs observed trash bins with tight fitted lids. Drinking water is readily available to children both indoors and outdoors. LPAs observed the facility’s paper sign in and out system and staff indicated that they also use an electronic system called ChildPlus. Facility has record of conducting fire drills at least every six months; last fire drill was conducted 09/20/2023. Playground equipment and surfaces are free of loose or sharp parts. There is sufficient equipment and toys, and there are shaded areas supplied by shade structures.

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. LPA observed a functional carbon monoxide detector.

PAGE 1. REPORT CONTINUES ON LIC809-C

SUPERVISOR'S NAME: Amanda Blesi	TELEPHONE: (916) 208-3427
LICENSING EVALUATOR NAME: Tanya Washington	TELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: HIRAM JOHNSON CENTER	FACILITY NUMBER: 343606947
	VISIT DATE: 09/27/2023

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
26
27
28
29
30
31
32

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For childcare center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/.

Facility Representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

PAGE 2. REPORT CONTINUES ON LIC809-C

SUPERVISOR'S NAME: Amanda Blesi	TELEPHONE: (916) 208-3427
LICENSING EVALUATOR NAME: Tanya Washington	TELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: HIRAM JOHNSON CENTER	FACILITY NUMBER: 343606947
	VISIT DATE: 09/27/2023

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
26
27
28
29
30
31
32

Facility Representative was informed of the www.mychildcareplan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

During today’s inspection no deficiencies were observed. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Facility Representative Demetila Casillas.

SUPERVISOR'S NAME: Amanda Blesi	TELEPHONE: (916) 208-3427
LICENSING EVALUATOR NAME: Tanya Washington	TELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023

LIC809 (FAS) - (06/04)

Page: 3 of 3