343616499-2-16-2023-03-CC-EPGO-CP4UCC-20230216142744

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343616499
Report Date: 02/16/2023
Date Signed: 02/16/2023 02:27:49 PM

Document Has Been Signed on 02/16/2023 02:27 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
RIVER CITY (SACTO)CC, 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: 5	DATE:	02/16/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Umarajeswari Kudupudi		TIME COMPLETED:	02:30 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	Licensing Program Analysts Erwina Pascual-Golamco Jennifer Velasco (LPA) met with Facility Representative, Director Umarajewari Kudupudi (D1) for an unannounced annual inspection. LPA toured the facility including all activity and classroom spaces, restrooms, food service and outdoor play areas. Census included 5 infant children being supervised by 2 staff. D1 was reminded never to exceed the conditions, limitations, and capacity specified on the license. Facility hours of operation are Monday through Friday from 7:00 AM to 6:00 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. LPA observed a current Needs and Services plan in each infant's file. LPA provided technical assistance regarding Infant Sleeping Plan (LIC9227) for each child under 12 months of age and sleep checks every 15 minutes for all children under two. LPA observed that all cribs were free of loose articles or objects and 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 of age-appropriate size, with no small parts for the safety of the infants. Classrooms all appeared clean including the carpets and floor. Chemicals were kept inaccessible to children. Playground equipment and surfaces were inspected and are in good condition with enough resilient material under climbing structures to cushion 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. 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: Natalie Dunaway	TELEPHONE: (916) 584-3508
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco	TELEPHONE: (916) 206-1524
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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: FOLSOM LAKE MONTESSORI ACADEMY	FACILITY NUMBER: 343616499
	VISIT DATE: 02/16/2023

NARRATIVE

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LPA observed labeled food and milk for infants, stored at safe temperatures. LPA observed staff documentation of feedings and diaper changes. LPA reviewed children’s files and staff files. Each child's file had the required licensing documentation. LPA reviewed staff transcripts and observed all staff caring for infants were qualified. At least one staff had a current Pediatric CPR and First Aid certification. Staff all have current Mandated Reporter certificates and proof of immunizations. LPA observed a current children's roster and a fire drill log. There is First Aid equipment available.

LPA and D1 discussed safe sleep regulations and the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed D1 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.

Incidental Medical Services (IMS) are provided by this facility. 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.

D1 was encouraged to the visit the department's website at WWW.CCLD.CA.GOV for information regarding childcare updates, PINs, forms, regulations and legislation pertaining to child care centers.

No deficiencies were cited during today's inspection. This report was reviewed with D1, and an exit interview was conducted. A Notice of Site Visit (NOS) was provided to D1, who will post it for a period of 30 days for parental review.

SUPERVISOR'S NAME: Natalie Dunaway	TELEPHONE: (916) 584-3508
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco	TELEPHONE: (916) 206-1524
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)

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