343611396-8-15-2019-03-CC-KGOL-BF3UUS-20190815155401

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343611396
Report Date: 08/15/2019
Date Signed: 08/15/2019 03:54:13 PM

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:	LINCOLN PLAZA MONTESSORI		FACILITY NUMBER:	343611396
ADMINISTRATOR:	JACOBSON, BRENDA		FACILITY TYPE:	830
ADDRESS:	400 Q STREET #1704		TELEPHONE:	(916) 795-4111
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95814
CAPACITY:	16	CENSUS:	DATE:	08/15/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Brenda Jacobson		TIME COMPLETED:	04:30 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	Licensing Program Analyst (LPA) Goodell met with Director Brenda Jacbson for an unannounced annual inspection. Today’s census was of 6 infant children with 2 staff in infant room 1 and 4 infant children with 2 staff infant room 2. All staff members present have obtained finger-print cleared through Community Care Licensing. Facility operates Monday-Friday, 6:30am-6:00pm. Facility located at the CalPERS with entrance located on R st. LPA toured the facility including all activity/classroom/napping areas, food service area and restrooms. LPA observed furniture and equipment. Director stated that the facility provides breakfast, morning/afternoon snack and lunch. LPA observed a current menu and activity schedules posted in on the parent board and each classroom. LPA observed cleaning compounds are inaccessible to children. Director stated there are no firearms, poisons, or bodies of water on the property. LPA observed that medications are centrally stored and inaccessible to children. LPA observed outdoor activity space, playground equipment and drinking water is made readily available to children both indoors and outdoors. LPA observed fire extinguisher 3A40BC and smoke detector. Director stated carbon monoxide detector is included in the facility's fire system. LPA observed changing tables and are located near a sink. LPA reviewed children files and observed Physician Reports, Identification and Emergency information, Infant’s Individual Feeding Plan and Infant’s Needs and Services plan. LPA reviewed staff's files and educational requirements, including the Infant course. LPA observed infant bottles are labeled and dated. LPA observed that several staff members present during today’s inspection have a current Pediatric CPR/First Aid that expires on 3/30/20. LPA observed fire drill log and child roster are maintained. Report continues on LIC 809-C

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kristal Goodell	TELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2019

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: LINCOLN PLAZA MONTESSORI	FACILITY NUMBER: 343611396
	VISIT DATE: 08/15/2019

NARRATIVE

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LPA also discussed Unusual Incident Reports (UIRs) and reporting requirements. LPA informed the Director that if any unusual incidents occur she must contact the Department within 24 hours and an UIR must be submitted with 7 day, describing the specifics to the incident. LPA provided the Community Care Licensing’s website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA advised the licensee of their responsibility to stay current in regards to new regulations.

No Title 22 Deficiencies cited. Report reviewed with Director. Notice of Site Visit issued and must remain posted for 30 days.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kristal Goodell	TELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2019

LIC809 (FAS) - (06/04)

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