343615667-2-16-2023-03-CC-TWAN-CP4SV3-20230216131204

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343615667
Report Date: 02/16/2023
Date Signed: 02/16/2023 04:38:22 PM

Document Has Been Signed on 02/16/2023 04:38 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 SCHOOL		FACILITY NUMBER:	343615667
ADMINISTRATOR:	DAWN WALKER		FACILITY TYPE:	850
ADDRESS:	5241 HARRISON STREET		TELEPHONE:	(916) 566-1900
CITY:	NORTH HIGHLANDS	STATE: CA	ZIP CODE:	95660
CAPACITY:	48	CENSUS: 14	DATE:	02/16/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:25 AM
MET WITH:	Keriann Madderra		TIME COMPLETED:	01:30 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	On Thursday, February 16, 2023, at 11:25 AM, Licensing Program Analyst (LPA) Tanya Washington met with the Facility Representative Keriann Madderra for an unannounced one year annual inspection. Upon arrival, LPA observed care and supervision of fourteen children with three staff on the playground. Shortly after LPAs arrival (ECE TOSA) Teacher on Special Assignment, Christine Bellucci arrived to the facility to assist the LPA with the remainder of the inspection. Facility is operating within the capacity and in compliance with staff child ratio on this day. The facility hours of operation are Monday through Friday from 7:00 AM to 5:00 PM. The facility does not offer transportation services. Facility provides breakfast, lunch, one afternoon snack and supper. During today's inspection, LPA did not inspect classroom #2 as it is occupied by a kindergarten class which is part of the elementary school. Facility Representative stated that classroom #2 is used in the afternoons for closer bathroom access and during school breaks. LPA and TOSA, Bellucci toured the grounds of the facility inside and out. LPA observed the facility has a functioning smoke detector, carbon monoxide detector, first aid supplies and a working telephone. There is fully charged fire extinguisher. All of the cleaning solutions, poisons and other chemicals that are dangerous to children are stored out of children's reach. Facility has age appropriate furniture. Furniture is steady and in good repair. LPA observed sufficient amount of cots, LPA observed that each cot is covered with a sheet. All bedding is stored in separate bags that are labeled with the child's name. Facility Representative stated that all sheets are cleaned at least once a week or when dirty or soiled. Facility shares the restroom with the school age children, children are escorted and supervised by staff while children are using the restroom. All storage containers for solid waste are in good repair and have proper tight - fitted lids. Facility has drinking water available for children inside, upon arrival at 11:25 AM, LPA did not observe drinking water for children while they were outside. All food is protected from contamination, all meals are prepared at the cafeteria of Madison Elementary school, children eat the snack in the classroom and the rest of the meals in the cafeteria under the supervision of staff. LPA reviewed storage and expiration dates of medication. LPA did not observe any expired medication. Continued on LIC809C

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya Washington	TELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023

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: MADISON ELEMENTARY SCHOOL	FACILITY NUMBER: 343615667
	VISIT DATE: 02/16/2023

NARRATIVE

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The play structure is age appropriate and is in good repair, LPA did not observe and sharp or loose parts. There is a sufficient amount of bark under the play structure to prevent a fall injury. There is a shared playground waiver on file. Facility staff follow the shared playground schedule.

LPA reviewed the facility records. Facility Representative stated stated, they use "Learning Genie" electronic sign in and out system and in case of power outage a paper sign in and out system is available. LPA observed the facility has license and all of the other required documents posted at the entrance of the classroom visible for the public.

LPA reviewed five random children's and three staff files. LPA observed facility has record of names, addresses and telephone numbers of each child's authorized representative. Facility Representative has a current CPR and First Aid certification which is valid until 06/2023. LPA observed that staff present are fully qualified and have the required ECE courses. LPA observed a current fire drill log. Facility has an updated children roster on file. Facility is aware that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. LPA observed required certification in each staff file.

All Child Care Centers (CCCs) that are located in buildings constructed before January 1, 2010 must have their drinking water tested for lead and post the results by January 1, 2023 and every 5 years after the date of the initial test. For a license issued on or after July 1, 2022, the CCC must have its water tested and post the results within 180 days of licensure. This facility has the water tested and submitted the result report to the department.

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 encouraged facility representative to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. Facility Representative can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for quarterly updates.

One Type B citation is issued on the following LIC809D. The copy of this report is reviewed and provided to TOSA, Bellucci. Notice of site visit is posted and shall remain posted for next 30 days. Appeal rights were provided.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya Washington	TELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

Document Has Been Signed on 02/16/2023 04:38 PM - It Cannot Be Edited

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/16/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101239.2(a)

Drinking Water

(a) Drinking water from a noncontaminating fixture or container shall be readily available both indoors and in the outdoor activity area. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/16/2023
	Plan of Correction
1 2 3 4	Facility Representative stated they will start brining out a pitcher of water and single use cups for outdoor use effective immediately. Facility Representative showed extra pitchers for water and singe use cups. LPA is clearing the deficiency effective today.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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) 263-5744
LICENSING EVALUATOR NAME: Tanya Washington	TELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023

LIC809 (FAS) - (06/04)

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