550320726-11-19-2024-53-CC-TLAE-DB6V9Z-20241119151509

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 550320726
Report Date: 11/19/2024
Date Signed: 11/19/2024 03:15:21 PM

Document Has Been Signed on 11/19/2024 03:15 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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	MOTHER LODE CHRISTIAN SCHOOL		FACILITY NUMBER:	550320726
ADMINISTRATOR/ DIRECTOR:	CRYSTAL WOLF		FACILITY TYPE:	850
ADDRESS:	18393 GARDNER AVENUE		TELEPHONE:	(209) 928-1916
CITY:	TUOLUMNE	STATE: CA	ZIP CODE:	95379
CAPACITY: 45	TOTAL ENROLLED CHILDREN: 45	CENSUS: 30	DATE:	11/19/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:45 AM
MET WITH:	Director, Crystal Wolf		TIME VISIT/ INSPECTION COMPLETED:	03:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 11/19/2024, Licensing Program Analyst (LPA) Tobias Lake met with Director, Crystal Wolf, for an unannounced required annual random inspection. LPA observed care and supervision of 30 children by 3 teachers and 3 aides in three classrooms. Operating hours are Monday-Friday from 7:30am to 5:30pm. LPA inspected all activity and classroom spaces, restrooms, food service, and outdoor play areas. Hazardous items are inaccessible to children. Furniture and equipment are in operable and safe condition. Playground equipment and surfaces are free of loose or sharp parts, and adequate cushioning was observed in areas underneath climbing equipment. Toileting facilities are in safe, sanitary, and operating condition. The floors appeared clean throughout the facility. The food preparation space is free of litter and all food was protected against contamination. Pre-prepared snacks are provided by the facility. Storage containers with solid waste have tight-fitting covers in each classroom. LPA observed a functional carbon monoxide detector. LPA observed posted menus showing planned meals at least one week in advance. Uncontaminated drinking water is readily available to children both indoors and outdoors. Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPA verified testing was completed in 2022. LPA observed full legal signatures while reviewing the sign in and sign out sheet. CONTINUED ON LIC809C.

Bettina Engelman	TELEPHONE: (916) 263-5820
Tobias Lake	TELEPHONE: 916-224-9388
	DATE: 11/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024

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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: MOTHER LODE CHRISTIAN SCHOOL	FACILITY NUMBER: 550320726
	VISIT DATE: 11/19/2024

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LPA reviewed records for all present staff. At least one staff member present today has current Pediatric CPR and First Aid certification. All staff currently employed with the facility have: a criminal record clearance, a health screening report, and documentation of their educational background, training, and/or experience.
7 children records were reviewed. Each child's file contained a completed emergency contact form, immunization records, signed personal rights form, and a completed medical assessment.
Facility has children with medication and LPA verified correct storage. Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.
To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.
All individuals subject to criminal record review have obtained clearance. Director was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.
Director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.
No deficiencies were observed during today’s inspection.
Exit interview conducted and report was reviewed with the Director, Crystal Wolf. A notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Appeal Rights were provided.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Tobias Lake	TELEPHONE: 916-224-9388
LICENSING EVALUATOR SIGNATURE:	DATE: 11/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024

LIC809 (FAS) - (06/04)

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