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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390313312
Report Date: 05/10/2023
Date Signed: 05/10/2023 02:54:55 PM


Document Has Been Signed on 05/10/2023 02:54 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:WEST VALLEY CHRISTIAN ACADEMY CHILD CARE-COUGAR CLFACILITY NUMBER:
390313312
ADMINISTRATOR:MICHELE SMITHFACILITY TYPE:
840
ADDRESS:1790 SEQUOIA BOULEVARDTELEPHONE:
(209) 835-2783
CITY:TRACYSTATE: CAZIP CODE:
95376
CAPACITY:112CENSUS: 0DATE:
05/10/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:54 PM
MET WITH:Michele Smith TIME COMPLETED:
03:00 PM
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On May 10, 2023, Licensing Program Analyst (LPA) Stacey Williams met with Facility Representative for the purpose of an unannounced required1 year inspection. The facility operates Monday- Friday, 7:00AM- 8:30 AM, and 2:50PM- 5:30PM. Upon arrival, there were no children present for the program. Criminal record clearances were verified.

LPA conducted a health and safety inspection for all areas accessible to children. There are no poisons on the premises. Toxic and hazardous items are inaccessible to children. Furniture and equipment are in good condition. LPA observed a functional smoke/carbon monoxide detector and a fully charged 2A :10BC fire extinguisher. The floors appeared clean throughout the facility. Outdoor play area is free from dangerous conditions and playground equipment is securely anchored to the ground. Facility uses bark under the play equipment to absorb falls. Program provides morning and afternoon snack. Menus were posted in the entry of the facility. The facility utilizes drinking water from water bottles. LPA discussed lead testing requirements of accessible water with the facility representative. Sign in/out is done electronically through the ProCare App.

Selected child files were reviewed. Staff files were also reviewed. Files contained the required documentation by regulation. LPA discussed mandated reporter training with the Director. Mandated Reporter Training is current in staff files that were reviewed. Mandated Reporter Training is to be completed every two years and can be accessed at www.mandatedreporterca.com. CPR/First Aid certification was reviewed. Expiration date is 7/2023 for the Director.

LPA reviewed the Department's inspection authority and discussed with staff any changes that may occur regarding Director/Site Supervisor or an employee acting in the director's absence must be reported to department within 10 working days.

Report continues on 809-C

SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Stacey WilliamsTELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:
DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/10/2023
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: WEST VALLEY CHRISTIAN ACADEMY CHILD CARE-COUGAR CL
FACILITY NUMBER: 390313312
VISIT DATE: 05/10/2023
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Facility representative was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

This facility provides Incidental Medical Services. Facility has an Incidental Medial Service Plan on file. Incidental Medical Services (IMS) policy was discussed. 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

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

No Title 22 deficiencies were observed during this inspection.

LPA reviewed report with the Facility Representative, Michele Smith and provided copies of the report along with Appeal Rights. A notice of site visit was provided and posted by LPA Williams and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Stacey WilliamsTELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023
LIC809 (FAS) - (06/04)
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