343616499-2-28-2020-03-CC-KFEA-BM8SBG-20200228124355

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343616499
Report Date: 02/28/2020
Date Signed: 02/28/2020 12:44:04 PM

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:	FOLSOM LAKE MONTESSORI ACADEMY		FACILITY NUMBER:	343616499
ADMINISTRATOR:	KUDUPUDI, UMARAJESWARI		FACILITY TYPE:	830
ADDRESS:	196 BLUE RAVINE RD. STE 150		TELEPHONE:	(916) 351-9448
CITY:	FOLSOM	STATE: CA	ZIP CODE:	95630
CAPACITY:	12	CENSUS: 7	DATE:	02/28/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Vasubabu Kudupudi		TIME COMPLETED:	02:00 PM

NARRATIVE

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Licensing Program Analyst (LPA) Kelly Ferrara met with Owner Vasubabu Kudupudi for the purpose of an unannounced random annual inspection. LPA toured the facility including all activity and classroom spaces, kitchen, restrooms, and outdoor play areas. Appropriate ratio and care and supervision were observed during today's inspection. Census included seven infant children being supervised by two staff. Owner was reminded never to exceed the conditions, limitations and capacity specified on the license. Facility hours of operation are Monday through Friday 7 AM-6 PM.

LPA observed a current Needs and Services plan for each infant in care. Bottles and baby food were kept in a refrigerator inside the classroom and were properly labeled with the child's name and date. Each crib has a fitted sheet and there were sheets and mats available for the older infants. All furnishings were in good condition. Staff stated that the bedding is changed daily. There is a separate area for cribs and LPA observed one staff in the nap area with infants sleeping. Infant diaper changing area is clean and within arm's reach of a sink. There is a one inch thick mat for the changing table with a vinyl surface. Toys are appropriate size with no small parts for the safety of the infants.

The infant classroom appeared clean including the carpets and floor. Chemicals were kept inaccessible to children on a high shelf. Playground equipment and surfaces were inspected and are in good condition with enough resilient material under climbing structures to absorb a fall. Uncontaminated drinking water was readily available to children both indoors and outdoors. Bathrooms were clean and all sinks and toilets were in operating condition. There are no firearms or bodies of water on the premises and the facility has at least one functioning smoke and carbon monoxide detector. Menus were posted for AM and PM snack and the facility provides lunch or children bring their own. LPA observed all required licensing documentation was posted for parental review. LPA observed that parents are signing their children in and out of the center electronically.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kelly Ferrara	TELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2020

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: FOLSOM LAKE MONTESSORI ACADEMY	FACILITY NUMBER: 343616499
	VISIT DATE: 02/28/2020

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A sample of children and staff files were reviewed. LPA observed that five out of six files were missing the Physician's Report (LIC701) and six out of six files were missing the Immunization Record (CDPH286). LPA observed the rest of the documentation was present for each child. Infant staff files contained all of the required documentation including proof of immunizations and Mandated Reporter training certification. LPA advised that this must be completed every two years. LPA reviewed infant staff transcripts and observed that they were qualified to work with infants. At least one staff had a current Pediatric CPR and First Aid certification that expires in October 2020 . LPA observed a current children's roster and the facility is completing their fire drills every six months.

Incidental Medical Services (IMS) policy was discussed. Each classroom was equipped with First Aid equipment. For additional IMS information, director was advised to 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 encouraged the Owner to the visit the department's website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to child care centers. LPA gave the Owner a copy of the Safe Sleep and Effects of Lead Exposure brochures. LPA discussed Assembly Bill 2370, which will require licensed Child Care facilities to test their water for excessive amounts of lead. Testing will be required beginning January 1st, 2020 to January 1st, 2023 and must be conducted every five years from initial testing.

The facility evaluation report was reviewed and discussed with the Owner. A notice of site visit was provided and should remain posted for a period of 30 days for parental review.

There was one Type B citation issued based on today's inspection.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kelly Ferrara	TELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2020

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: FOLSOM LAKE MONTESSORI ACADEMY	FACILITY NUMBER: 343616499
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/28/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/06/2020 Section Cited	1 2 3 4 5 6 7	Child’s Records. The licensee shall ensure that there are separate, complete and current records kept for each child attending the child care center. This requirement is not met as evidenced by: LPA observed 5/6 files were missing the Physician's Report (LIC701), and 6/6 files were missing the Immunization record (CDPH286). This poses a potential
	8 9 10 11 12 13 14	health and safety risk to children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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 Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kelly Ferrara	TELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2020

LIC809 (FAS) - (06/04)

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