343616796-9-13-2019-03-CC-KGUA-BFYPJH-20190913112135

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343616796
Report Date: 09/13/2019
Date Signed: 09/13/2019 11:21:43 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:	OUR LADY OF THE ASSUMPTION		FACILITY NUMBER:	343616796
ADMINISTRATOR:	GUTIERREZ, YESENIA		FACILITY TYPE:	850
ADDRESS:	5055 COTTAGE WAY		TELEPHONE:	(916) 485-1504
CITY:	CARMICHAEL	STATE: CA	ZIP CODE:	95608
CAPACITY:	30	CENSUS: 0	DATE:	09/13/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Yesenia Gutierrez		TIME COMPLETED:	11:35 AM

NARRATIVE

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Licensing Program Analyst (LPA) Karyn Guerra met with Director Yesenia Gutierrez for the purpose of an unannounced annual random inspection. Director was reminded never to exceed the conditions, limitations, and capacity specified on the license. No children were in care during time of inspection. Hours of operation for the facility are 8:00AM-3:00PM, Monday thru Friday. School year traditionally runs from August to May.

LPA toured the facility including classrooms, restrooms, food service areas, and outdoor play areas. LPA observed the following documents are posted: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, menus, and daily schedule. Cleaning disinfectants and hazardous items are appropriately stored and inaccessible to children. Currently, no children in care require medications. Director stated there are no poisons on the premises. Furniture and equipment are in good condition, and toileting facilities are in safe, sanitary, and operating condition. Bins for solid waste have tight fitting lids. The floors appeared clean throughout the facility. The food preparation space is free of litter, and all food was protected against contamination. Program provides morning and afternoon snack. Lunch is provided by parents.

Uncontaminated drinking water is available to children indoors and outdoors. Facility utilizes an electronic sign in and sign out program. Playground equipment and surfaces are free of loose or sharp parts. There is a sufficient amount of outdoor shade provided by trees.

Report continues on 809-C.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 216-7796
LICENSING EVALUATOR NAME: Karyn Guerra	TELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2019

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: OUR LADY OF THE ASSUMPTION	FACILITY NUMBER: 343616796
	VISIT DATE: 09/13/2019

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Staff and children's records were reviewed. Each child's file contained an emergency card and a health history. At least one staff member present today has current Pediatric CPR and First Aid certification (exp. 8/2021). All staff currently employed with the facility have a criminal record clearance, health screening report, immunization records, current AB 1207 Mandated Reporter training certificates, and documentation of the educational background, training, and/or experience. There are no firearms or bodies of water on the premises. LPA observed a functional carbon monoxide detector that is hardwired into the fire alarm system. LPA reviewed the Department's inspection authority and discussed with Director any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within ten working days.

The facility is not currently providing IMS services. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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.

LPA verified the annual fees are current. LPA provided the Child Care Advocates Program email address: childcareadvocatesprogram@dss.ca.gov, so Director and can request to be added to the distribution list to receive Quarterly Updates. LPA provided and discussed Effects of Lead Exposure and Safe Sleep brochures.

This facility evaluation report was reviewed and discussed with the Director. A Notice of Site Visit was provided and should remain posted for a period of 30 days for parental review. Director was encouraged to the visit the Department's website at WWW.CDSS.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining child care centers. An exit interview was conducted.

In the areas that were evaluated, no deficiencies were observed at the time of the inspection.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 216-7796
LICENSING EVALUATOR NAME: Karyn Guerra	TELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2019

LIC809 (FAS) - (06/04)

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