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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343619915
Report Date: 03/26/2024
Date Signed: 03/26/2024 01:21:38 PM


Document Has Been Signed on 03/26/2024 01:21 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:LIL' SCHOOL, THEFACILITY NUMBER:
343619915
ADMINISTRATOR:ROWE-JOHNSON, GLORIAFACILITY TYPE:
850
ADDRESS:8089 MADISON AVENUE #11TELEPHONE:
(916) 962-2137
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:75CENSUS: DATE:
03/26/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:28 PM
MET WITH:Gloria Rowe-JohnsonTIME COMPLETED:
01:30 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Stephanie Piring and Licensing Program Manager (LPM) Natalie Dunaway , met with Facility Representative, Gloria Rowe-Johnson (Director), for a case management visit regarding an incident that occurred on 03/13/24. Purpose of the visit was explained.

The facility representative self reported to the department and submitted a written Unusual Incident Report LIC624 on 03/14/24, a child was able to get through two gates to the school age playground while out on the preschool playground with their class. During today's inspection, LPA observed the classroom, play yard, and interviewed the Director. Director stated that the staff member was giving a 10 minute break, and when the regular staff returned, they conducted name to face protocol and realized a child was not present. The child was able to get thought two gates and was found on the slide on the school age yard. The director shared the Fire Marshall recently asked that the gates were changed where the push bar is at children's level. Director stated the staff in charge of supervision during the break was released from employment and a safety protocol training was conducted with all staff on 3/21/24.

Based on observation, documentation, and interview, Title 22 Deficiencies have been issued on the attached LIC 809-D page. The Facility Representative was informed that this report dated 03/26/24 documents one Type A citation and must be posted for parental review for 30 consecutive days. The facility must also provide a copy of this licensing report to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in each child's file for verification.

An exit interview was conducted with Facility Representative, Gloria Rowe-Johnson, and a notice of site was given and must remain posted for 30 days. Appeal Rights were provided.

SUPERVISOR'S NAME: Natalie DunawayTELEPHONE: (916) 263-5714
LICENSING EVALUATOR NAME: Stephanie PiringTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 03/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 03/26/2024 01:21 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827


FACILITY NAME: LIL' SCHOOL, THE
FACILITY NUMBER: 343619915

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/27/1012
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision
(a)The licensee shall provide care and supervision ...to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time...shall include visual observation.
This requirement is not met as evidenced by:
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Director stated that staff memeber was released from employment, and a safety protocol training was conducted on 3/21/24 for all staff. Director will email copies of training documentation and staff attendance records to LPA by 4PM POC due date.
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based on observation and interview Facility did not comply with the section cited above as a child was left unsupervised in the play yard, for approximately 10 minutes, which poses an immediate health, safety, or personal rights risk to persons in care.
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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: Natalie DunawayTELEPHONE: (916) 263-5714
LICENSING EVALUATOR NAME: Stephanie PiringTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 03/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/26/2024
LIC809 (FAS) - (06/04)
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