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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343621719
Report Date: 12/22/2021
Date Signed: 02/25/2022 10:22:50 AM


Document Has Been Signed on 02/25/2022 10:22 AM - 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:VINELAND PRESCHOOLFACILITY NUMBER:
343621719
ADMINISTRATOR:CUNNION, ELIZABETHFACILITY TYPE:
850
ADDRESS:6450 20TH STREETTELEPHONE:
(916) 566-1616
CITY:RIO LINDASTATE: CAZIP CODE:
95673
CAPACITY:30CENSUS: 6DATE:
12/22/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Stephanie WilkinsonTIME COMPLETED:
10:35 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Fabiola Diaz and Amanda Sutter met with staff Stephanie Wilkinson to follow up on an Unusual Incident Report (UIR) submitted to Community Care Licensing on 12/07/21. During today's visit the facility was toured. Present were 6 preschool children. We then met with Lena Sanders, ECE TOSA.

LPAs interviewed staff regarding the incident. It was explained that Child 1 (C1) was walking in a line with other children to the playground with 2 staff, when C1 was left unattended for a couple of minutes. C1 was then seen by another staff. C1 did not acquire injuries during the incident. C1's parents were notified the day of the incident.

The facility did not report the unusual incident report to Community Care Licensing within 24 hours. An advisory note was provided. A written UIR was submitted within 7 days, describing the specifics of the incident.

Deficiencies were cited on today’s date. LPAs informed Lena Sanders that this report dated 2/25/22 documents 1 Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.
Also, LPAs informed Lena to provide a copy of this licensing report dated 2/25/22 that documents any Type A citation(s) 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 the child's file for verification.

LPAs reviewed and discussed this report with Lena. A notice of site visit was given and must remain posted for 30 days. Appeal Rights were provided.

SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Fabiola DiazTELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:
DATE: 12/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/22/2021
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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Document Has Been Signed on 02/25/2022 10:22 AM - 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: VINELAND PRESCHOOL
FACILITY NUMBER: 343621719

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/22/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/26/2022
Section Cited

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101229 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision... (1) No child(ren) shall be left without the supervision of a teacher at any time...Supervision shall include visual observation. This requiremen is not met as evidenced by:
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Based on interview, the
licensee did not ensure to maintain supervion of child (C1) at all times. This poses an immediate Health, Safety, and
Personal Rights risk to children in care.
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LPA was informed that staff now have a chart to track the number of students walking to the playground. Children also use a walking rope.

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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: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Fabiola DiazTELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:
DATE: 02/25/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/25/2022
LIC809 (FAS) - (06/04)
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