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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343615667
Report Date: 03/28/2022
Date Signed: 03/28/2022 03:47:00 PM


Document Has Been Signed on 03/28/2022 03:47 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833



FACILITY NAME:MADISON ELEMENTARY SCHOOLFACILITY NUMBER:
343615667
ADMINISTRATOR:DAWN WALKERFACILITY TYPE:
850
ADDRESS:5241 HARRISON STREETTELEPHONE:
(916) 335-4788
CITY:NORTH HIGHLANDSSTATE: CAZIP CODE:
95660
CAPACITY:48CENSUS: 6DATE:
03/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Dawn Walker and Lena SaundersTIME COMPLETED:
12:40 PM
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On March 28, 2022, at approximately 10:40 AM, Licensing Program Analyst (LPA) Tanya Washington met with Site Supervisor, Dawn Walker for the purpose of an unannounced required 1 year annual inspection. Upon arrival, LPA observed six children supervised by three staff. Shortly after, Lena Saunders, Teacher on Special Assignment arrived to the facility to assist LPA. The facility hours of operation are Monday through Friday from 7:00 AM to 5:00 PM. The facility does not offer transportation services.

LPA toured all activity and classroom spaces restrooms and outdoor play area. LPA discussed current COVID19 guidelines with Site Supervisor. LPA observed the following documents are posted: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, daily schedule and menu. Cleaning disinfectants and hazardous items are appropriately stored and inaccessible to children. Site Supervisor stated that there are currently no children in care requiring medication. Site Supervisor 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, and the floors appeared to be clean throughout the facility. The program provides breakfast, two snacks, lunch and supper.

LPA observed trash bins with tight fitted lids. Drinking water is readily available to children both indoors and outdoors. Site Supervisor stated that they use "Learning Genie" electronic sign in and out system. Facility has record of conducting fire drills at least once every six months; the last drill was conducted on March 4, 2022. Playground equipment and surfaces are free of loose or sharp parts and there is a sufficient amount of bark to absorb a fall. There are sufficient equipment and toys, and there are shaded areas supplied by building awning. Licensing fees are current.


Report continues on LIC809-C.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya WashingtonTELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:
DATE: 03/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/28/2022
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 2


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: 03/28/2022
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Two staff and six children's records were reviewed. Both children and staff files were observed to be complete. At least one staff member present today has a current Pediatric CPR and First Aid certification that expires on 10/2023. LPA observed a current children’s roster, Site Supervisor understands it is to be maintained for three years. LPA observed a functional carbon monoxide detector, smoke detector and fire extinguisher. LPA reminded Site Supervisor that 100% supervision is required at all times. 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

Site Supervisor 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.

During today’s inspection no deficiencies were observed. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Lena Saunders and Dawn Walker.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya WashingtonTELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2022
LIC809 (FAS) - (06/04)
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