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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343610546
Report Date: 02/08/2022
Date Signed: 02/08/2022 04:21:28 PM


Document Has Been Signed on 02/08/2022 04:21 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:RANCH, THEFACILITY NUMBER:
343610546
ADMINISTRATOR:SPENCER, ANNAFACILITY TYPE:
850
ADDRESS:7879 VAN VLECK RD.TELEPHONE:
(916) 354-0369
CITY:RANCHO MURIETASTATE: CAZIP CODE:
95683
CAPACITY:14CENSUS: 12DATE:
02/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Spencer, AnneTIME COMPLETED:
04:45 PM
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On February 8, 2022, at approximately 1:45 PM, Licensing Program Analyst (LPA) Alize Tillery met with Director Anne Spencer for the purpose of an unannounced required 1 year annual inspection. Upon arrival, LPA observed 12 preschool children supervised by 2 staff members and the Director, in the outdoor play area. LPA observed Staff #1 to be missing from the facility roster. The facility hours of operation are Monday through Friday from 8:15 AM to 11:45 AM and 12:30 PM to 4:30 PM. The facility does not offer transportation services.

LPA toured all activity and classroom spaces, kitchen, restroom and outdoor play area. 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. Director 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 is part day, therefore nap time is not offered. The program provides snacks if children forget to bring their own from home.



LPA observed trash bins with tight fitted lids. Drinking water is readily available to children both indoors and outdoors. Director stated that there are water pitchers and disposable cups, accessible to children both indoors and outdoors. LPA observed the facility’s sign in and out sheet at the entrance. Facility has record of conducting fire drills at least every six months; last fire drill was conducted on 1/13/2022. LPA observed 2A10BC fire extinguisher, carbon monoxide detector and smoke detector. Playground equipment and surfaces are free of loose or sharp parts. The areas around and under the climbing structure is cushioned with bark. Director stated that the climbing structure is anchored in. LPA observed there to be sufficient equipment and toys, and there are shaded areas supplied by trees.
Report continues on 809-C.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Alize TilleryTELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:
DATE: 02/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/08/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: RANCH, THE
FACILITY NUMBER: 343610546
VISIT DATE: 02/08/2022
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2 staff and 6 children's records were reviewed. All children files were observed to be complete. LPA reminded Director that all staff must provide proof of immunization against MMR and TDAP prior to an individual working or volunteering at a child care center. Director was reminded that in order to qualify staff for an exemption of this, the exemption must come from the individual’s physician. At least one staff member present today has a current Pediatric CPR and First Aid certification that expires on 8/23/2023. LPA reminded Director to keep a current Children’s Roster on file, that is to be maintained for three years. LPA provided Director with the LIC 9040 for reference. LPA reminded Director that 100% supervision is required at all times. 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



Director 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.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Alize TilleryTELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2022
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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: RANCH, THE
FACILITY NUMBER: 343610546
VISIT DATE: 02/08/2022
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During today’s inspection, a type A deficiency was cited. Upon receipt, licensee shall post and provide copies of this licensing report to parents/ guardians of children who are currently enrolled as well as parents/guardians of children newly enroll at the facility during the next 12 months. Parents/guardians must acknowledge receipt of this report and citation by signing a LIC 9224, “ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS”. A copy of this form should be placed in each child file upon receipt from parent.

A Notice of Site Visit was issued, and Director acknowledges it must remain posted for 30 days.

An exit interview was conducted, appeal rights were issued and discussed, and report was reviewed with the Director, Anne Spencer.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Alize TilleryTELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/08/2022 04:21 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: RANCH, THE
FACILITY NUMBER: 343610546

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/08/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Request Denied
Type A
Section Cited
CCR
101170(e)(1)
Criminal Record Clearance
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in that staff #1 is not fingerprint cleared, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/09/2022
Plan of Correction
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Director will provide LPA Tillery correspondence stating that she will ensure employees and volunteers are fingerprint cleared an associated to her roster prior to their presence in the facility.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Alize TilleryTELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:
DATE: 02/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/08/2022
LIC809 (FAS) - (06/04)
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