343616499-3-2-2022-03-CC-KFEA-CC5SYZ-20220302131824

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343616499
Report Date: 03/02/2022
Date Signed: 03/02/2022 01:18:30 PM

Document Has Been Signed on 03/02/2022 01:18 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:	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: 6	DATE:	03/02/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Vasu and Uma Kudupudi		TIME COMPLETED:	02:00 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	Licensing Program Analysts (LPAs) Kelly Ferrara and Katy Maestas met with Facility Representatives Vasu and Uma Kudupudi for an unannounced annual inspection on Wednesday, March 2nd. At 9:15 AM, LPAs toured the facility including all activity and classroom spaces, restrooms, food service and outdoor play areas. Census included six children in care with four staff. Facility Representative was reminded never to exceed the conditions, limitations and capacity specified on the license. Facility hours of operation are Monday through Friday 7 AM to 6 PM. Facility Representative 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. LPAs observed a current Needs and Services plan for each infant in care. LPAs observed an Infant Sleeping Plan (LIC9227) for each child under 12 months of age. LPAs observed documentation that sleep checks were being conducted by staff every 15 minutes for all children under two. Bottles and baby food were kept in a refrigerator inside the classroom and LPAs discussed properly labeling the bottles with the child's name and date. LPAs observed a sleeping infant with a blanket in the crib and LPAs discussed the safe sleep regulation includes blankets and loose articles. LPAs observed there was one crib or mat for each child in care with a tight fitted sheet. All furnishings were in good condition. Staff stated that the bedding is changed daily. 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. Classrooms all appeared clean including the carpets and floor. Chemicals and cleaning materials were kept inaccessible to children. 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 children are provided lunches.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Kelly Ferrara	TELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:	DATE: 03/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2022

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: FOLSOM LAKE MONTESSORI ACADEMY	FACILITY NUMBER: 343616499
	VISIT DATE: 03/02/2022

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
26
27
28
29
30
31
32

At 11 AM, staff files were reviewed. LPAs reviewed staff transcripts and observed all staff being utilized as teachers were qualified. LPAs observed proof of immunizations for the staff. At least one staff had a current Pediatric CPR and First Aid certification that expires August 2022. LPAs observed the sample of children’s files contained the appropriate documents. LPA observed a current children's roster and a fire/disaster drill log. The facility is equipped with First Aid equipment.
LPA discussed the safe sleep regulations with Facility Representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. 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

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/inspection-process.
Facility Representative was encouraged to the visit the Department's website at WWW.CCLD.CA.GOV for information regarding child care updates, PINs, forms, regulations and legislation pertaining to child care centers.
No deficiencies were cited based on today’s inspection, however a technical advisory was issued. Exit interview was conducted and report was reviewed with the Facility Representative. A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Kelly Ferrara	TELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:	DATE: 03/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2022

LIC809 (FAS) - (06/04)

Page: 2 of 2