343616158-1-24-2024-03-CC-DVAG-CZSS57-20240124123353

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343616158
Report Date: 01/24/2024
Date Signed: 01/24/2024 12:33:59 PM

Document Has Been Signed on 01/24/2024 12:33 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	SACRAMENTO ADVENTIST ACADEMY		FACILITY NUMBER:	343616158
ADMINISTRATOR:	SHARI THOMPSON		FACILITY TYPE:	850
ADDRESS:	5601 WINDING WAY		TELEPHONE:	(916) 481-2300
CITY:	CARMICHAEL	STATE: CA	ZIP CODE:	95608
CAPACITY:	48	CENSUS: 36	DATE:	01/24/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Shari Thompson		TIME COMPLETED:	01:00 PM

NARRATIVE

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At 9:00 a.m. on Wednesday, January24th, 2023, Licensing Program Analyst (LPA) Pa Dao Vang met with Director, Shari Thompson, for the purpose of an unannounced, required - 3 year inspection. LPA observed a census of 36 children supervised by 5 staff. Facility hours of operation are from 7:00 a.m. - 5:00 p.m., Monday thru Friday. Center provide a.m and p.m snack for the children. Parents provide children's lunch from home.

Director 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.

LPA conducted a health and safety inspection of the classroom, and restrooms. LPA observed the following documents are posted: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, and menus. Director stated that there are no firearms nor poisons on the premises. LPA observed an expired fire drill log with the last date of 1/8/2024.

Facility provides Incidental Medical Services. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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 conducted a health and safety inspection of the outdoor space. Playground equipment and surfaces were free of loose or sharp parts. Outdoor shade was provided by canopies. Water is accessible via labeled bottles.

Continue report on LIC809-C...

SUPERVISOR'S NAME: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Dao Vang	TELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

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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Document Has Been Signed on 01/24/2024 12:33 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SACRAMENTO ADVENTIST ACADEMY	FACILITY NUMBER: 343616158
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/24/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.7995(a)(1)

General Provisions and Definitions

(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. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record reviews, the licensee did not comply with the section cited above in 1 out of 5 staff are missing their MMR and Tdap immunization in their personnel files, which posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/26/2024
	Plan of Correction
1 2 3 4	Staff will locate MMR & Tdap records and keep a copy of them in their personnel files. Director will email LPA Vang at padao.vang@dss.ca.gov proof of MMR & Tdap records.

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: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Dao Vang	TELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SACRAMENTO ADVENTIST ACADEMY	FACILITY NUMBER: 343616158
	VISIT DATE: 01/24/2024

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LPA reviewed staff and children's records. Each child's file contained an admission agreement, emergency card, health history, and acknowledgement of receipt of personal rights, consent for emergency medical treatment, and parent’s rights. LPA observed CPR and First aid certification for at least one staff on the facility premises. LPA observed current AB 1207 Mandated Reporter training certificates, employee rights, and documentation of the educational background, training, and/or experience. There is at least 1 staff with current CRP/First Aid certification. LPA did not observe MMR and Tdap in 2 staff's personnel files.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for

drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

Facility Representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

A Title 22 deficiency is being cited on the subsequent page of this report in accordance with the California Code of Regulations. An exit interview was conducted with the Director, Shari Thompson. Appeal rights and a notice of site visit were provided. Notice of site visit shall remain posted for a period of 30 days.

SUPERVISOR'S NAME: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Dao Vang	TELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

LIC809 (FAS) - (06/04)

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