343617467-4-24-2023-03-CC-KGUA-CR7QY8-20230424123443

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343617467
Report Date: 04/24/2023
Date Signed: 04/24/2023 12:34:54 PM

Document Has Been Signed on 04/24/2023 12:34 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:	PENLEIGH CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	343617467
ADMINISTRATOR:	MARIVEL CAMASURA		FACILITY TYPE:	850
ADDRESS:	1400 E STREET, SUITES D & E		TELEPHONE:	(916) 822-5020
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95814
CAPACITY:	29	CENSUS: 22	DATE:	04/24/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Marivel Camasura		TIME COMPLETED:	12:50 PM

NARRATIVE

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At 9:20 a.m. on Monday, April 24th, 2023, Licensing Program Analyst (LPA) Karyn Guerra, and Licensing Program Manager, Seychelle De Luca, met with Licensee, Marivel, Camasura for the purpose of an unannounced required 1 year required inspection. Operating hours of the facility are from 7:00 a.m.-5:30 p.m., Monday thru Friday. Licensee guided LPA on a tour of the facility, at which time a census of 22 preschool children supervised by 4 staff was observed.

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.

A health and safety inspection was conducted in the 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. Director stated there are no poisons on the premises. Furniture and equipment are in good condition, and toileting facilities are in sanitary, and operating condition. Hot water in bathroom sink was hot to the touch. Bins for solid waste in the have tight fitting lids. The floors appeared clean throughout the facility. The facility provides morning and afternoon snack. The food preparation space is free of litter. Food was not protected against contamination. Drinking water was readily available to children both indoors and outdoors via drinking fountains and labeled bottles. Facility uses an online application for sign in and sign out. LPA observed full legal signatures of authorized representatives. There are no firearms or bodies of water on

Report continues 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: 04/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2023

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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: PENLEIGH CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 343617467
	VISIT DATE: 04/24/2023

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the premises. LPA observed a functional carbon monoxide detector. LPA discussed exposed metal piping on seesaw. Playground equipment was exposed to environmental elements and showed signs of wear. Outdoor shade was provided by shade sails.

Staff files were reviewed. At least one staff member present today has current Pediatric CPR and First Aid certification. Immunization records and updated mandated reporter training certificates were missing from some staff files. LPA observed documentation of educational background training and/or experience.

Children's records were reviewed. Each child's file contained an emergency card, consent for emergency medical treatment and notifications of children’s and parent’s rights, health history, physician's report and immunization records.

This facility provides Incidental Medical Services – IMS. LPA discussed plan of operation. 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. LPA advised getting a larger box for storage. LPA observed expired medication for two children.

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/process.

Title 22 deficiencies were cited on the subsequent pages of this report. Appeal rights were provided. Exit interview conducted and report was reviewed with the Licensee, Marivel Camasura. 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: 04/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/24/2023 12:34 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: PENLEIGH CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 343617467
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/24/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101217(a)

Personnel Records

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above as mandated reporter training was not current and immunization records were missing for some staff, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/24/2023
	Plan of Correction
1 2 3 4	Licensee will provide personnel record documentation by POC due date.

Type B

Section Cited

CCR

101226(e)(4)(A)

Health-Related Services

(4) Nonprescription medications may be administered without approval or instructions from the child's physician if all of the following conditions are met: (A) Nonprescription medications shall be administered in accordance with the product label directions on the nonprescription medication container(s). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above as expired medicationw as observed in medication box, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/05/2023
	Plan of Correction
1 2 3 4	Licensee will provide documentation of communication with parents by POC due date.

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: 04/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2023

LIC809 (FAS) - (06/04)

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