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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343615514
Report Date: 10/24/2019
Date Signed: 10/24/2019 10:59:59 AM

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:ST. CHARLES BORROMEO SCHOOL PRE-KFACILITY NUMBER:
343615514
ADMINISTRATOR:LEAH QUACKENBUSHFACILITY TYPE:
850
ADDRESS:7580 CENTER PARKWAYTELEPHONE:
(916) 421-6189
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY:30CENSUS: 7DATE:
10/24/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:10 AM
MET WITH:Leah QuackenbushTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Elvira Sierra met with Leah Quackenbush for the purpose of an unannounced annual random inspection. Census included 7 preschool children supervised by 2 staff members. Facility operates from M-F, during school calendar: 08:00 AM – 03:30 PM. The preschool program operates in the St. Charles Borromeo School in the Pre-K classroom.

LPA toured all activity and classroom spaces, restrooms, food service, and outdoor play areas. Director stated there are no poisons on the premises. 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 with wood chips to absorb the fall. Toileting facilities are in safe, sanitary and operating condition. The floors appeared clean throughout the facility. Program provides morning snacks; Director stated that all children currently enrolled are only half day from 08:00 AM to 11:30 PM. Drinking water was readily available indoor and outdoors by water bottles that are label with the student's name.

There are no firearms or bodies of water on the premises. LPA observed a functional carbon monoxide detector. LPA reviewed the Department's inspection authority and discussed with Director 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. LPA reminded Diretor that 100% supervision is required at all times, including in the bathroom.


Staff and children's records were reviewed. All staff currently employed with the facility have a criminal record clearance. Director was reminded before working or volunteering in a licensed child care facility, all individuals subject to a criminal record review have a clearance or exemption and have been associated to the facility. Report continued on subsuquent page 809C-------------
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira SierraTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2019
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: ST. CHARLES BORROMEO SCHOOL PRE-K
FACILITY NUMBER: 343615514
VISIT DATE: 10/24/2019
NARRATIVE
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Director was reminded never to exceed the conditions, limitations and capacity specified on the license.
At least one staff member present today has current Pediatric CPR and First Aid certification (exp. 08/20). Full legal signatures and time was observed in sign in/out sheets.
A Plan of Operation will be sent to LPA. 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.

LPA reviewed AB 1207- California Child Care Worker: Mandated Reporter Training. Staff must complete the training every two years starting January 1, 2018 and retain proof of completion in the facility file. The training can be could at: mandatedreporterca.com. LPA observed proof of Mandated certificate on file.

Effects of Lead exposure and Quarterly Update Summer 2019 publications were provided to Director.

Director was updated on new immunization requirements from the Department of Public Health(CDHP) that will become effective July 1, 2019. Additional information and resources can be found on the https://www.shotsforschool.org website.

LPA verified the annual fees are current.

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. LPA provided the Child Care Advocates Program email address: childcareadvocatesprogram@dss.ca.gov, so Director can request to be added to the distribution list to receive Quarterly Updates. Director was encouraged to the visit the department's website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining child care centers. See page 809D for deficiencies cited under Title 22.

SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira SierraTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2019
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: ST. CHARLES BORROMEO SCHOOL PRE-K
FACILITY NUMBER: 343615514
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/24/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/22/2019
Section Cited

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101217 Personnel Records (a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information:(6) Documentation of the educational background, training and/or experience specified in this chapter.
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This requirements was not met as evidence by;
File for lead teacher was missing documentation for educational background. This is a violation that if not corrected can pose a safe and healthy risk to the children in care.
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Type B
11/22/2019
Section Cited

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§1596.7995 Employees or volunteers at day care center; immunization requirements; records; exemptions.(a) (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.

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This condition was not met as evidence by;
LPA did not observed any immunization record on staff files. This is a violation that if not corrected can pose a heatlth and safety risk to the children in care.
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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: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira SierraTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:
DATE: 10/24/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/24/2019
LIC809 (FAS) - (06/04)
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