343615667-1-23-2020-03-CC-TWAN-BL4Q8D-20200123105635

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343615667
Report Date: 01/23/2020
Date Signed: 01/23/2020 10:56:42 AM

COMPREHENSIVE INSPECTION

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:	MADISON ELEMENTARY SCHOOL		FACILITY NUMBER:	343615667
ADMINISTRATOR:	NAOMI JANSSEN		FACILITY TYPE:	850
ADDRESS:	5241 HARRISON STREET		TELEPHONE:	(916) 566-1900
CITY:	NORTH HIGHLANDS	STATE: CA	ZIP CODE:	95660
CAPACITY:	48	CENSUS: 18	DATE:	01/23/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Naomi Janssen		TIME COMPLETED:	10:20 AM

NARRATIVE

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Licensing Program Analyst (LPA) Tanya Washington met with Director Naomi Janssen for the purpose of an unannounced annual required inspection. Director was reminded never to exceed the conditions, limitations, and capacity specified on the license. LPA observed care and supervision of 18 children observed by 3 staff. Facility hours of operation are Monday through Friday from 7 AM to 5 PM. Director stated that during the school year the only classroom utilized is room #2 and the enrollment remains at 24 children.

LPA toured classroom #2, restrooms, and outdoor play area. Director stated that currently there are no children in care requiring medication. 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 facility shares the playground with Madison Elementary school, and have obtained a waiver. Playground equipment is cushioned with wood chips to absorb the fall. The facility has a waiver to share additional toileting facilities with Madison Elementary School. The toileting facilities are in safe, sanitary, and operating condition. The floors appeared clean throughout the facility.

Storage containers with solid waste have tight-fitting covers. Program provides breakfast, lunch and snack that is delivered to the classroom by the Twin Rivers School District Cafeteria. Menus were posted and drinking water was readily available to children indoors and outdoors. LPA observed a sign in and out book with full legal signatures.

Staff and children's records were reviewed. Each child's file contained an emergency card and a medical assessment. At least one staff member present today has current Pediatric CPR and First Aid certification (exp. 06/08/20).

Report continues on LIC809-C.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya Washington	TELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2020

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: MADISON ELEMENTARY SCHOOL	FACILITY NUMBER: 343615667
	VISIT DATE: 01/23/2020

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All staff currently employed with the facility have a criminal record clearance through the school district and documentation of the educational background, training, and/or experience. LPA reminded Director that 100% supervision is required at all times, including in the bathroom. 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 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.

LPA observed current Mandated Reporter Training for staff; Staff is aware to renew the certification every two years.

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 discussed and provided the “Effects of Lead Exposure” brochures and advised the Director to share the brochures with parents. LPA provided the following link:http://www.cdss.ca.gov/inforesources/Community-Care-Licensing/subscribe for the Licensee to subscribe to the distribution list and receive Quarterly Updates.

This facility evaluation report was reviewed and discussed with Director. 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. An exit interview was conducted.

Notice of site visit posted. No deficiencies are observed during today's inspection.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya Washington	TELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2020

LIC809 (FAS) - (06/04)

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