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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343611397
Report Date: 12/03/2021
Date Signed: 12/03/2021 01:21:00 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 MONTESSORIFACILITY NUMBER:
343611397
ADMINISTRATOR:JACOBSON, BRENDAFACILITY TYPE:
850
ADDRESS:400 Q STREET, #1704TELEPHONE:
(916) 795-4111
CITY:SACRAMENTOSTATE: CAZIP CODE:
95814
CAPACITY:59CENSUS: 37DATE:
12/03/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Brenda JacobsonTIME COMPLETED:
01:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Alize Tillery and Licensing Program Manager (LPM) Seychelle De Luca met with Licensees Brenda Jacobson and Kristen Miller for the purpose of an unannounced required 1 year annual inspection. Upon arrival, LPA observed 9 toddler children supervised by 3 staff, and 28 preschool children, supervised by 4 staff. The facility hours of operation are Monday through Friday from 6:30 AM to 6:00 PM.

LPAs toured all activity and classroom spaces (classrooms: Toddler 1, Toddler 2, Preschool 1 and Preschool 2), kitchen, restrooms and outdoor play area. LPAs observed all children to be without masks. LPA discussed current COVID19 mandates and guidelines with Licensees. 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. LPAs suggested that the classroom rugs be deep cleaned, and licensees were reminded to keep bedding sheets separate and labeled. The program provides breakfast, lunch and two snacks.



Drinking water is readily available to children both indoors and outdoors. Director stated that there is a water pitcher that is used and there are paper cups accessible to children. LPAs observed the facility’s sign in and out sheet. Playground equipment and surfaces are free of loose or sharp parts. There are sufficient equipment and toys. There are shaded areas supplied by the building and 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: 12/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2021
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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: LINCOLN PLAZA MONTESSORI
FACILITY NUMBER: 343611397
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/03/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that two staff members did not have immunizations on file which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/17/2021
Plan of Correction
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Licensee will submit proof to LPA Tillery of staff 1 and staff 2 immunizations records.
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: 12/03/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/03/2021
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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: LINCOLN PLAZA MONTESSORI
FACILITY NUMBER: 343611397
VISIT DATE: 12/03/2021
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4 staff and 10 children's records were reviewed. Each child's file was observed to be complete. At least one staff member present today has a current Pediatric CPR and First Aid certification. LPA observed two staff files that were missing immunization records. LPAs reminded Licensees that all staff are to have current Mandated Reporter certificates, trainings to be completed every 2 years. LPAs reminded Licensees that 100% supervision is required at all times. LPAs observed a functional carbon monoxide detector, smoke detector and fire extinguisher. 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.

A notice of site visit was given and must remain posted for 30 days. Deficiencies are cited on the following, 809D page.

Exit interview conducted and report was reviewed with the Licensees, Brenda Jacobson and Kristen Miller.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Alize TilleryTELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2021
LIC809 (FAS) - (06/04)
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