343612177-9-22-2023-53-CC-NMAS-CN9RQW-20230120121413

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343612177
Report Date: 01/20/2023
Date Signed: 09/22/2023 12:03:22 PM

Document Has Been Signed on 09/22/2023 12:03 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 S. CC RO, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME:	SETA - GRIZZLY HOLLOW HEAD START		FACILITY NUMBER:	343612177
ADMINISTRATOR:	LOPEZ, MARLO		FACILITY TYPE:	850
ADDRESS:	805 ELK HILLS DRIVE		TELEPHONE:	(209) 744-7728
CITY:	GALT	STATE: CA	ZIP CODE:	95632
CAPACITY:	40	CENSUS:	DATE:	01/20/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Marlo Lopez		TIME COMPLETED:	12:30 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 Katy Maestas (LPA) and Licensing Program Manager Jeanne Smith (LPM) conducted a field visit to the facility for the purpose of an unannounced annual inspection. LPA disclosed the purpose of the inspection and was granted entrance into the facility. LPA and LPM met with the Director Marlo Lopez (D1). LPA and LPM toured the facility inside and outside. No children were present during the inspection. LPA accessed Guardian to verify that all required adults were background cleared. LPA observed that hazardous items (disinfectants, cleaning solutions etc.) were inaccessible to children in care. Facility days and hours of operation for the preschool are Monday-Thursday from 8:00 AM to 4:00 PM. The facility provides breakfast, lunch and snacks. LPA conducted a file review prior to inspection and verified that annual fees were current. While on location, LPA and LPM reviewed care and supervision of children, staffing ratios, medications, first aid supplies, furniture, equipment, fire drills, and drinking water. LPA observed all required forms to be posted. There appear to be adequate toys and equipment available for children. LPA toured the outdoor play area, and inspected 2 play structures; both structures appeared to be in good repair and provide adequate shade. LPA observed sufficient cushioning under the play structures to prevent injury. LPA reviewed the sign in/out procedures on the facilities tablets for electronic signatures. LPA and LPM reviewed children’s and staff files. LPA observed Health Screening Reports with TB test and required MMR and TDAP vaccines for all staff members. At least one staff member present today had current Pediatric CPR and First Aid (exp. 03/2024). LPA observed current Mandated Reporter training for all staff. D1 was reminded to renew the course every 2 years. This training requirement may be met by using the Department’s Office of Child Abuse Prevention (OCAP) online training modules. The OCAP modules are free of cost and available at: http://www.mandatedreporterca.com/. The training is currently provided in English and Spanish. Report continues on 809-C

SUPERVISOR'S NAME: Jeanne Smith	TELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Nola Maestas	TELEPHONE: 916-926-9100
LICENSING EVALUATOR SIGNATURE:	DATE: 01/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023

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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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: SETA - GRIZZLY HOLLOW HEAD START	FACILITY NUMBER: 343612177
	VISIT DATE: 01/20/2023

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Incidental Medical Services (IMS) policy was discussed with D1. For IMS information, see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was 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.

D1 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

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/inspection-process.

In the areas that were evaluated, no deficiencies were cited during today’s inspection. LPA conducted an Exit Interview and the report was reviewed with D1. A Notice of Site visit was posted by LPA and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Jeanne Smith	TELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Nola Maestas	TELEPHONE: 916-926-9100
LICENSING EVALUATOR SIGNATURE:	DATE: 01/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023

LIC809 (FAS) - (06/04)

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