343615334-10-2-2019-03-CC-JKEY-BGKSKT-20191002135717

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343615334
Report Date: 10/02/2019
Date Signed: 10/02/2019 01:57:28 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:	4TH R - H. ALLEN HIGHT		FACILITY NUMBER:	343615334
ADMINISTRATOR:	WINSCOTT, JENNIFER		FACILITY TYPE:	840
ADDRESS:	3200 NORTH PARK DRIVE		TELEPHONE:	(916) 566-6422
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95835
CAPACITY:	100	CENSUS: 0	DATE:	10/02/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	See Her, Program Developer		TIME COMPLETED:	02:15 PM

NARRATIVE

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Licensing Program Analysts (LPAs) Joleen Kenney and Seychelle De Luca met with Program Developer See Her for the purpose of an unannounced annual random inspection. Program Developer was reminded never to exceed the conditions, limitations, and capacity specified on the license. Facility hours of operation are Monday through Friday from 7:00 a.m. to 8:00 a.m. for the morning session and 2:00 p.m. to 6:00 p.m. for the afternoon session. Classrooms are located on the school grounds and operates during the school calendar only.

LPAs toured all activity and classroom spaces, food service, and outdoor play areas. Medications are stored appropriately and are inaccessible to children. Program Developer stated there are no poisons. Toxic and hazardous items are inaccessible to children. Furniture and equipment are in good condition. Playground equipment and surfaces are free of loose or sharp parts. The areas around or under climbing equipment are cushioned to absorb the fall. The children use the school toileting facilities. The floors appeared clean throughout the facility. The food preparation space is free of litter and all food was protected against contamination. Storage containers with solid waste have tight-fitting covers. Program provides afternoon snack. Menus were posted and drinking water was readily available to children both indoors and outdoors. LPAs observed full legal signatures while reviewing the sign-in and sign-out sheet as required for school- age component.

Staff and children's records were reviewed. Each child's file contained an emergency card and a consent for medical treatment. At least one staff member present today has current Pediatric CPR and First Aid certification (exp. 1/16/2020). All staff currently employed with the facility have a health screening report. LPAs were unable to verify the educational requirements for staff because no transcripts were on file at the facility. LPAs observed that some staff files were missing proof of immunization's and mandated reporter trainining.

Report continues on 809-C.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Joleen Kenney	TELEPHONE: (916) 799-9668
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2019

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: 4TH R - H. ALLEN HIGHT	FACILITY NUMBER: 343615334
	VISIT DATE: 10/02/2019

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There are no firearms or bodies of water on the premises. LPAs discussed the requirement for a carbon monoxide detector. LPAs reviewed the Department's inspection authority and discussed with Program Developer 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.

A Plan of Operation is available in the facility file. 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 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.

LPAs provided and discussed Effects of Lead Exposure brochure.

This facility evaluation report was reviewed and discussed with Director. A Notice of Site Visit was provided and should remain posted for a period of 30 days for parental review. Director was encouraged to visit the department's website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining child care centers.

The following Type B deficiency is cited on the following page because the staff files were incomplete. Exit interview was conducted.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Joleen Kenney	TELEPHONE: (916) 799-9668
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2019

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: 4TH R - H. ALLEN HIGHT	FACILITY NUMBER: 343615334
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/02/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/01/2019 Section Cited	1 2 3 4 5 6 7	Personnel Records - The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. This requirement is not met as evidenced by LPA's file review. LPA observed all staff files are incomplete.
	8 9 10 11 12 13 14	LPA left a list of missing items for the Program Coordinator which includes proof of immunization's for pertussis, measles and influenza, mandated reporter training, and transcripts. This poses a potential health and safety concern.	8 9 10 11 12 13 14
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	1 2 3 4 5 6 7

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: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Joleen Kenney	TELEPHONE: (916) 799-9668
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2019

LIC809 (FAS) - (06/04)

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