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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343619958
Report Date: 12/06/2023
Date Signed: 12/06/2023 03:14:30 PM


Document Has Been Signed on 12/06/2023 03:14 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:PACIFIC CHILDREN'S CENTERFACILITY NUMBER:
343619958
ADMINISTRATOR:NANCY MCCOLLFACILITY TYPE:
830
ADDRESS:6560 MELROSE DRIVETELEPHONE:
(916) 566-1600
CITY:NORTH HIGHLANDSSTATE: CAZIP CODE:
95660
CAPACITY:25CENSUS: 15DATE:
12/06/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Nancy McCollTIME COMPLETED:
12:05 PM
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On Wednesday, December 6, 2023, Licensing Program Analyst (LPA) Tanya Washington met with Facility Representative, Nancy McColl for the purpose of an unannounced required annual inspection. LPA observed seven toddlers between the age of 18-36 months supervised by three staff in room #2 and seven infants supervised by four staff in room #1. All individuals subject to criminal background are cleared through Twin Rivers School district. Shortly after LPAs arrival, District Office Site Supervisor (DO), Reem Zidan arrived to the facility to assist LPA. The facility hours of operation are Monday through Friday from 7:00 AM to 5:00 PM.

LPA toured classroom spaces, restrooms, and outdoor play areas. LPA learned that recently the district added a separate infant playground which is designated for infants ages 6-23 months old. This area is separated by a fence and staff indicated that infants have exclusive use of that area from the toddler children since September, 2022. LPA did not observe any shade over the newly built play area or anywhere in the fenced perimeter of the newly added play area. LPA also observed a new play structure for the toddler children in the toddler playground. Both playgrounds have artificial grass installed to absorb a fall. Artificial grass is not one of the approved materials listed in the regulations and facility needs to submit a request for the material to be approved. LPA observed the following documents are posted: License, Parents' Rights Poster, menu, schedule, lead testing brochure, child personal rights, and seat belt law. LPA observed a functional carbon monoxide detector. Cleaning disinfectants, medications and hazardous items are appropriately stored and inaccessible to children. Facility Representative stated that all bedding is washed on site on weekly basis, or more often if needed. LPA observed changing tables in arms reach of a sink. Facility Representative stated there are no poisons or firearms on the premises. Furniture and equipment are in good condition, and toileting facilities are in safe, sanitary, and operating condition. LPA observed infant bottles labeled with children’s names and dates in the refrigerator. All meals are delivered to the facility from the school district. Facility provides breakfast, AM snack, lunch and supper.

PAGE 1. REPORT CONTINUES ON LIC809-C

SUPERVISOR'S NAME: Amanda BlesiTELEPHONE: (916) 208-3427
LICENSING EVALUATOR NAME: Tanya WashingtonTELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:
DATE: 12/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/06/2023
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 4


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: PACIFIC CHILDREN'S CENTER
FACILITY NUMBER: 343619958
VISIT DATE: 12/06/2023
NARRATIVE
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LPA observed trash bins with tight fitted lids. Facility utilizes electronic sign in/out system called Learning Genie. In case of malfunction of the system there is a paper version of the sign in/ out log. Facility has record of conducting fire drills at least every six months; last fire drill was conducted on 11/15/2023. LPA observed children’s roster. Playground equipment and surfaces are free of loose or sharp parts. There are sufficient equipment and toys, LPA observed a shaded area in the toddler yard. Staff indicated that use labeled sippy cups for infant and toddler children both indoors and outdoors.

Five staff and eight children's records were reviewed. Both children and staff files were observed to be complete. LPA observed infant needs and services plans, infant sleep plan (LIC 9227), and 15-minute observation checks for napping infants. There is at least one staff member present with a current CPR certificate.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

LPA discussed the safe sleep regulations with director 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 Facility Representative 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.


PAGE 2. REPORT CONTINUES ON LIC809-C
SUPERVISOR'S NAME: Amanda BlesiTELEPHONE: (916) 208-3427
LICENSING EVALUATOR NAME: Tanya WashingtonTELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: PACIFIC CHILDREN'S CENTER
FACILITY NUMBER: 343619958
VISIT DATE: 12/06/2023
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Facility Representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Facility Representative was informed of the www.MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

LPA confirmed that the annual fees are current. LPA informed the Facility Representative of the recent regional office relocation and provided updated personal and parent's rights forms and postings.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Two Type B deficiencies are cited on the following LIC809D. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Facility Representative Reem Zidan. Appeal rights were provided.

SUPERVISOR'S NAME: Amanda BlesiTELEPHONE: (916) 208-3427
LICENSING EVALUATOR NAME: Tanya WashingtonTELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 12/06/2023 03:14 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: PACIFIC CHILDREN'S CENTER
FACILITY NUMBER: 343619958

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238.2(b)(1)
Outdoor Activity Space
(1) Provide a shaded rest area for the children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. LPA learned that the facility has been utilizing infant outdoor area since September 2022.
POC Due Date: 01/08/2024
Plan of Correction
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Facility will come up with a plan to ensure there is shaded area for children.
Type B
Section Cited
CCR
101238.2(e)
Outdoor Activity Space
(e) As a condition of licensure, the areas around and under high climbing equipment, swings, slides and other similar equipment shall be cushioned with material that absorbs falls.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. LPA observed artificial grass under the play structures. This material is not one of the approved materials listed in the regulations. This material needed approval from CCL prior to installation.
POC Due Date: 01/08/2024
Plan of Correction
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Facility Representative will contact the manufacturer of the artificial grass to see if the cushioning is sufficient enough to absorb a fall and to ensure this material is safe for infants during hot temperature.
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: Amanda BlesiTELEPHONE: (916) 208-3427
LICENSING EVALUATOR NAME: Tanya WashingtonTELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:
DATE: 12/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/06/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4