343621304-9-12-2019-53-CC-ASIA-BFXTGT-20190912144341

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343621304
Report Date: 09/12/2019
Date Signed: 09/12/2019 02:43:47 PM

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:	CDC - PLEASANT GROVE PRESCHOOL		FACILITY NUMBER:	343621304
ADMINISTRATOR:	BRUMFIELD, CASSANDRA		FACILITY TYPE:	850
ADDRESS:	10160 PLEASANT GROVE RD		TELEPHONE:	(916) 686-1260
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95624
CAPACITY:	20	CENSUS: 0	DATE:	09/12/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Cassandra Brumfield		TIME COMPLETED:	03:00 PM

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Licensing Program Analyst (LPA) Amy Silva and Licensing Program Manager Maria Mayorga met with Director Cassandra for the purpose of an unannounced random annual inspection. Upon arrival, there was one staff and no children present. Facility hours of operation are Monday through Friday from 7:00 AM to 6:00 PM.

LPA toured both classrooms, restrooms, and outdoor play areas. Toileting facilities are in safe, sanitary, and operating condition. The floors appeared clean throughout the facility. Director stated there are no poisons on the premises. Toxic and hazardous items are inaccessible to children. Furniture and equipment are in good condition. All food was protected against contamination. Storage containers with solid waste have tight-fitting covers. Program provides breakfast, morning snacks and afternoon snacks. Menus were posted. Drinking water was readily available to children both indoors and outdoors. Currently, 0 children in care require medications. LPA observed full legal signatures while reviewing the sign in and sign out sheet.

Three staff and four children's records were reviewed. Each child's file contained an emergency card and a medical assessment. At least one staff member present today has current Pediatric CPR and First Aid certification (exp. 5/18/2020). Mandated reporter training is current for all staff.

Report continues on 809-C.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Amy Silva	TELEPHONE: (916) 926-9100
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2019

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: CDC - PLEASANT GROVE PRESCHOOL	FACILITY NUMBER: 343621304
	VISIT DATE: 09/12/2019

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All staff currently employed with the facility have a criminal record clearance, health screening report, mandated reporter training certificates, immunization records, 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. LPA reminded Director that 100% supervision is required at all times.

Facility is providing Incidental Medical Services. 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 provided and discussed Effects of Lead Exposure brochure and the revised CDPH 286 form for the documentation of immunization's.

This facility evaluation report was reviewed and discussed with 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 and in the areas that were evaluated, no deficiencies were observed at the time of the inspection.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Amy Silva	TELEPHONE: (916) 926-9100
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2019

LIC809 (FAS) - (06/04)

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