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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343610266
Report Date: 07/26/2023
Date Signed: 07/26/2023 03:11:06 PM


Document Has Been Signed on 07/26/2023 03:11 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:CADENCE EDUCATION LLC - CLARKSVILLEFACILITY NUMBER:
343610266
ADMINISTRATOR:SANDRA HAINESFACILITY TYPE:
850
ADDRESS:76 CLARKSVILLE ROADTELEPHONE:
(916) 983-0224
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY:180CENSUS: 132DATE:
07/26/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Sandra HainesTIME COMPLETED:
03:15 PM
NARRATIVE
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On July 26th, Licensing Program Analyst, Soleil Marx met with Facility Representative, Sandra Haines, for an unannounced case management inspection following a self reported unusual incident report.
Today's census included 132 preschool children in care with ten staff, during nap time.

Sacramento Regional Office received an Unusual Incident Report from the facility regarding an incident that occurred on June 9th, 2023. During today's inspection, LPA interviewed the Director regarding the incident. LPA learned that a staff member pulled a child's ear as a form of discipline. The staff member was immediately terminated following the incident.

Based on the information received, a violation of Title 22 regulations has occurred.

One Type A deficiency was cited on the attached LIC 809D and a civil penalty was assessed regarding an absence of supervision. Upon receipt of a Type A citation, licensee shall post and provide copies of the LIC 809 D for parents/guardians of children in care and for parents/guardians of newly enrolled children for the next 12 months. Licensee must also keep the signed LIC 9224, acknowledging receipt of LIC 809 D in each child's file.

Exit interview was conducted and a copy of this report was given to Facility Representative, Sandra Haines. Notice of site was given and must remain posted for 30 days. Appeal rights provided.

SUPERVISOR'S NAME: Natalie DunawayTELEPHONE: (916) 584-3508
LICENSING EVALUATOR NAME: Soleil MarxTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/26/2023
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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Document Has Been Signed on 07/26/2023 03:11 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827


FACILITY NAME: CADENCE EDUCATION LLC - CLARKSVILLE
FACILITY NUMBER: 343610266

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/27/2023
Section Cited
CCR
101223(a)(3)

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101223 Personal Rights
(a) The licensee shall ensure that each child is accorded the following personal rights:
(3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature
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Facility terminated the staff member immediately.

The defeciency was cleared during today's visit.
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This requirement is not met as evidenced by:

Based on a self reported incident report submitted to SAC RO, a staff member pulled a childs ear as a form of discipline which poses an immediate Health, Safety, or Personal Rights risk to persons in care.
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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: Natalie DunawayTELEPHONE: (916) 584-3508
LICENSING EVALUATOR NAME: Soleil MarxTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 07/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/26/2023
LIC809 (FAS) - (06/04)
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