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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343610267
Report Date: 03/20/2024
Date Signed: 03/20/2024 01:38:15 PM


Document Has Been Signed on 03/20/2024 01:38 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:CADENCE EDUCATION LLC - CLARKSVILLEFACILITY NUMBER:
343610267
ADMINISTRATOR:SANDRA HAINESFACILITY TYPE:
830
ADDRESS:76 CLARKSVILLE ROADTELEPHONE:
(916) 983-0224
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY:38CENSUS: 27DATE:
03/20/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Sandra HainesTIME COMPLETED:
01:40 PM
NARRATIVE
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An unannounced case management inspection was conducted by Licensing Program Analyst (LPA) Soleil Marx and LPA Jennifer Velasco. LPA met with facility representative, Director Sandra Haines (Director), who was advised of the purpose of this inspection. This inspection was conducted to follow up on a 02/22/2024 unusual incident that was self-reported to Community Care Licensing (CCL) as required. During this inspection, LPA toured the facility, conducted interviews, and reviewed relevant facility documentation.

LPA informed Director that this report documents one Type A citation and must be posted for 30 consecutive days as there was immediate risk to the health, safety, and/or personal rights of children in care. LPA informed Director to provide a copy of this licensing report that documents a Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other equivalent written statement, must be placed in the child's file for verification. Exit interview with Director Sandra Haines was conducted, and appeal rights were provided. Notice of site visit was provided and must be posted for 30 consecutive days for parental review.

See continuation page LIC 9099-D for deficiency.
SUPERVISOR'S NAME: Natalie DunawayTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jennifer VelascoTELEPHONE: 707-953-7341
LICENSING EVALUATOR SIGNATURE:
DATE: 03/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/20/2024
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 03/20/2024 01:38 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: 343610267

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/21/2024
Section Cited
CCR
101427(c)

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Infant Care Food Service: (c) The infant shall be fed in accordance with the individual plan. This requirement was not met as evidenced by witness statements and facility documentation of a self-reported incident in which
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Director Sandra Haines stated one staff's employment ended and remaining staff were provided with additional training on safe food service for infants. Director stated they will provide documentation of trraining materials on or before close of business on POC due date. POC met during inspection.
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 an infant was given another infant's bottle instead of the bottle intended for that infant. This constituted an immediate threat to the health, safety, and/or personal rights of infants 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) 263-1414
LICENSING EVALUATOR NAME: Jennifer VelascoTELEPHONE: 707-953-7341
LICENSING EVALUATOR SIGNATURE:
DATE: 03/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/20/2024
LIC809 (FAS) - (06/04)
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