343616543-5-31-2022-03-CC-KGUA-CEXVPS-20220531163715

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343616543
Report Date: 05/31/2022
Date Signed: 05/31/2022 04:37:23 PM

Document Has Been Signed on 05/31/2022 04:37 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:	SAN JUAN PRE-SCHOOL		FACILITY NUMBER:	343616543
ADMINISTRATOR:	LEWIS, JENNY		FACILITY TYPE:	830
ADDRESS:	7413 WISCONSIN DRIVE		TELEPHONE:	(916) 863-0337
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95610
CAPACITY:	12	CENSUS: 6	DATE:	05/31/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Jenny Lewis		TIME COMPLETED:	04:40 PM

NARRATIVE

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At 1:15 p.m., on Tuesday, May 31st, 2022, Licensing Program Analyst (LPA) Karyn Guerra met with Director, Jenny Lewis, for the purpose of a 1 year- required inspection. Census consisted of 6 infant children supervised by 2 staff, Hours of operation are from 6:00 a.m. – 6:00 p.m., Monday thru Friday.

All individuals subject to criminal background review have obtained criminal record clearance. 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, restrooms, and food service areas. LPA observed the following documents are posted: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, car seat laws, menus, and daily schedule. Cleaning disinfectants and hazardous items are appropriately stored and inaccessible to children. Director stated that there are no firearms nor poisons on the premises. LPA observed a changing table within arm's reach of a sink. Changing table has raised sides. Bins for solid waste have tight fitting lids. The floors appeared clean throughout the facility. Infant food is provided by parents/guardians. LPA observed some prepared milk bottles labeled with children's names in the refrigerator. LPA observed prepared formula in a plastic water bottle without a label. Staff stated it was for Child 1 (C1). Other food in the facility was properly stored to prevent contamination. Drinking water is provided to children via labeled water bottles. LPA did not observe sign in and sign out logs with full legal signature of parent/guardians. Director stated that staff sign children in and out on the ProCare App.

No children in care require medications. Incidental Medical Services – IMS was discussed. 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.

Report continued on 809-C.

SUPERVISOR'S NAME: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Karyn Guerra	TELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2022

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: SAN JUAN PRE-SCHOOL	FACILITY NUMBER: 343616543
	VISIT DATE: 05/31/2022

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LPA discussed the safe sleep regulations with licensee 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. Director understands that an individual infant sleeping plan LIC9227 must be on file for all infants up to 12 months of age. Napping infant children over 12 months were observed napping on cots in the crib area of the classroom. LPA did not observe napping logs documenting 15 minute checks of napping children.

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 trees. Water is accessible via pitcher and cups.

LPA reviewed staff and children's records. Each child's file contained an admission agreement, emergency card, health history, immunizations, 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 health screening, staff immunization records, current AB 1207 Mandated Reporter training certificates, employee rights, and documentation of the educational background, training, and/or experience in some staff files. Files were incomplete.

A staff interview was conducted with Director, Jenny Lewis.

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/process.

Title 22 deficiencies are cited on the subsequent pages of this report. Exit interview conducted and report was reviewed with the Director, Jenny Lewis. Appeal rights were provided. Director's signature on this report acknowledges receipt of these rights. A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Karyn Guerra	TELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2022

LIC809 (FAS) - (06/04)

Page: 2 of 3

Document Has Been Signed on 05/31/2022 04:37 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: SAN JUAN PRE-SCHOOL	FACILITY NUMBER: 343616543
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/31/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101427(j)

Infant Care Food Service

(j) Bottles, dishes and containers of food brought by the infant's authorized representative shall be labeled with the infant's name and the current date. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above as LPA observed formula in an unlabeled water bottle for C1, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/30/2022
	Plan of Correction
1 2 3 4	Director will send a notice to parents that infant formula and brestmilk will be received preared in labeled milk bottles and will supply proof of notification to LPA by POC due date.

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: Karyn Guerra	TELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2022

LIC809 (FAS) - (06/04)

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