343616702-4-25-2019-03-CC-CBEO-BBKNKQ-20190425103218

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343616702
Report Date: 04/25/2019
Date Signed: 04/25/2019 10:32:25 AM

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:	CAMELLIA PRESCHOOL		FACILITY NUMBER:	343616702
ADMINISTRATOR:	HAMMOND, ALYCE		FACILITY TYPE:	850
ADDRESS:	6600 COUGAR DRIVE		TELEPHONE:	(916) 395-4520
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95828
CAPACITY:	25	CENSUS: 23	DATE:	04/25/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Sierra Appleby		TIME COMPLETED:	10:45 AM

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 Analyst (LPA) Christopher Bello conducted an unannounced random annual inspection today. Upon arrival LPA was greeted by Lead teacher, Sierra Appleby. A tour of the facility was conducted inside and outside. The following areas are in compliance during the inspection. There are no bodies of water. Firearms and ammunition are not on the premises. Storage for poisons are locked. Disinfectants, hazardous items and medications are inaccessible to children. Furniture and equipment are sufficient, age appropriate and in good repair. Fire drills are conducted and documented. Carbon Monoxide detectors were present. The playground equipment and outdoor activity space is maintained and in good condition. Wood chips are being used as cushioning around the climbing equipment and level is sufficient to absorb a fall. Children's toilets, hand washing facilities are sanitary. Floors are clean and free of debris. Food preparation is conducted by the elementary school. Drinking water is available both indoors and outside. The facility is in compliance with conditions and limitations specified on the license. Sign in/sign out sheets are maintained. No excluded individuals are present. Staff subject to a criminal record clearance or exemption are associated to the facility. First Aid/CPR reviewed and in compliance. Emergency information reviewed for some children. Some staff records were reviewed. 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 Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. 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. Mandated Reporter Training on file. LPA checked facilities fees and confirmed that it is up to date. REPORT CONTINUES ON NEXT PAGE.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Christopher Bello	TELEPHONE: (916) 862-0844
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2019

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: CAMELLIA PRESCHOOL	FACILITY NUMBER: 343616702
	VISIT DATE: 04/25/2019

NARRATIVE

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LPA provided the Community Care Licensing’s website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA advised licensee of their responsibility to stay current in regards to new regulations. LPA also included the email address for the children's advocacy program to stay current on new laws CHILDCAREADVOCATESPROGRAM@DSS.CA.GOV.

No Title 22 Deficiencies observed in the areas that were evaluated. LPA reviewed report with the director and provided copies. An exist interview was conducted. LPA observed the Notice of Site Visit posted and the director understands it must remain posted for 30 days.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Christopher Bello	TELEPHONE: (916) 862-0844
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2019

LIC809 (FAS) - (06/04)

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