343620058-10-23-2019-03-CC-KFEA-BH8Q4E-20191023115014

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343620058
Report Date: 09/18/2019
Date Signed: 10/23/2019 11:50:23 AM

COMPREHENSIVE INSPECTION

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME:	CARL SUNDAHL ELEMENTARY SCHOOL-MONTESSORI PROGRAM		FACILITY NUMBER:	343620058
ADMINISTRATOR:	HIMMRICH, MONIKA		FACILITY TYPE:	850
ADDRESS:	9932 INWOOD ROAD		TELEPHONE:	(916) 294-2425
CITY:	FOLSOM	STATE: CA	ZIP CODE:	95630
CAPACITY:	25	CENSUS: 22	DATE:	09/18/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Monika Himmrich		TIME COMPLETED:	02:00 PM

NARRATIVE

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Licensing Program Analysts (LPAs) Kelly Ferrara and Mai Lor met with Director Monika Himmrich for the purpose of an unannounced random annual inspection. LPAs toured the classroom including all activity and classroom spaces, restrooms, and outdoor play area. All staff receive fingerprint clearance through the school district. Appropriate ratio and care and supervision were observed during today's inspection. Census included 22 preschool children being supervised by two staff. Director was reminded never to exceed the conditions, limitations and capacity specified on the license. The facility operates according to the Folsom Cordova School District schedule and has a morning program that operates Monday through Friday from 8:25 AM- 12:10 PM.

The program provides snack that is brought in by the parents and the Kindergarten children receive lunch in the cafeteria (waiver on file.) LPAs observed the Licensing forms were posted including: Parents Rights, Personal Rights, Carseat laws, Emergency Disaster Plan, and Activities Calendar. The classroom appeared clean and in good repair and the playground equipment and surfaces were inspected and safe. The areas around or under the climbing equipment are cushioned with a resilient material to absorb a fall and there is adequate shade. Uncontaminated drinking water was readily available to children both indoors and outdoors. Bathroom was clean and all sinks and toilets were in operating condition. The classroom has a smoke detector and carbon monoxide detector that was tested and are functioning. LPAs observed a cubby available for each child and a binder for the parents to sign their children in and out of the facility.

A sample of children and staff files were reviewed. LPAs observed six out of 15 files were missing the Physician's Report (LIC701) and 15 out of 15 files were missing the Parent's Report (LIC702). All staff files contained the required documentation. At least one staff present today has current Pediatric CPR and First Aid certification that expires in April 2020. LPA observed a current children's roster and a fire drill was conducted on August 22nd, 2019. LPAs requested that Director send in an updated Personnel Report (LIC500), Designation of Responsibility (LIC308), and Emergency and Disaster Plan (LIC610).

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kelly Ferrara	TELEPHONE: (916) 425-5935
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2019

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: CARL SUNDAHL ELEMENTARY SCHOOL-MONTESSORI PROGRAM	FACILITY NUMBER: 343620058
	VISIT DATE: 09/18/2019

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LPAs observed that all staff had completed a training through Works International regarding Mandated Reporting. A waiver request was approved for all school sites in the Folsom Cordova district to use this training in place of Mandatedreporterca.com. LPA advised Director that a copy of this waiver would be sent to the facility and should be kept in each staff's file.

Incidental Medical Services (IMS) is provided by the facility. Medication is kept in the original packaging and staff have been trained. The facility has a first aid box with ample supplies. For additional IMS information, director was advised to see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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.

This facility evaluation report was reviewed and discussed with the Director. Director was encouraged to the visit the departments website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to child care centers. LPA gave the Director a hand out on the Effects of Lead Exposure and a hand out on Active Supervision. A notice of site visit was provided and should remain posted for a period of 30 days for parental review.

Based on today's inspection, there was one Type B deficiency cited.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kelly Ferrara	TELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2019

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: CARL SUNDAHL ELEMENTARY SCHOOL-MONTESSORI PROGRAM	FACILITY NUMBER: 343620058
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/18/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/18/2019 Section Cited	1 2 3 4 5 6 7	Child’s Records. The licensee shall ensure that there are separate, complete and current records kept for each child attending the child care center. This requirement is not met as evidenced by: LPAs observed 15/15 files were missing the Parent's Report (LIC702) and 6/15 files were missing the Physician's Report (LIC701).
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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: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kelly Ferrara	TELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2019

LIC809 (FAS) - (06/04)

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