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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343622006
Report Date: 07/12/2022
Date Signed: 07/12/2022 02:10:28 PM


Document Has Been Signed on 07/12/2022 02:10 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833



FACILITY NAME:APPLE A DAY PRESCHOOL & INFANT CTR (PS)FACILITY NUMBER:
343622006
ADMINISTRATOR:FARFAN, LILIYAFACILITY TYPE:
850
ADDRESS:5013 EL CAMINO AVETELEPHONE:
(916) 481-5400
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:36CENSUS: 15DATE:
07/12/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Lilya FarfanTIME COMPLETED:
02:15 PM
NARRATIVE
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At 10:15 a.m. on Tuesday, July 12th, 2022, Licensing Program Analyst (LPA) Karyn Guerra met with Director, Liliya Farfan, for the purpose of an unannounced, case management inspection. During today's inspection, LPA observed Staff 1 (S1) alone with 13 children in care outside at 10:25 a.m. and 10:52 a.m., while Staff 2 (S2) was assisting children with the restroom indoors.

Title 22 deficiencies are cited on the subsequent pages of this report. Director acknowledges, that FOR TYPE A DEFICIENCIES ONLY upon receipt, licensee shall post LIC 809D with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the licensee. LIC 9224 and Appeal Rights were provided. Director's signature on this report acknowledges receipt of these rights. This report was reviewed with the Director. An exit interview was conducted. A Notice of Site Visit was provided and shall remain posted for a period of 30 days for parental review.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:
DATE: 07/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/12/2022
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 07/12/2022 02:10 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833


FACILITY NAME: APPLE A DAY PRESCHOOL & INFANT CTR (PS)
FACILITY NUMBER: 343622006

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/12/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/13/2022
Section Cited

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101216 Teacher-Child Ratio (a)There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance...This requirement was not met, as evidenced by:
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Based on observations, Staff 1 (S1) was alone supervising 13 children outdoors. This poses an immediate risk to the health and safety of children 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: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:
DATE: 07/12/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/12/2022
LIC809 (FAS) - (06/04)
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