573621066-6-28-2023-53-CC-JTES-CT8NVR-20230628104822

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 573621066
Report Date: 06/28/2023
Date Signed: 06/28/2023 10:48:28 AM

Document Has Been Signed on 06/28/2023 10:48 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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	DCCNS		FACILITY NUMBER:	573621066
ADMINISTRATOR:	ALLEWELT-SMITH, LIZ		FACILITY TYPE:	850
ADDRESS:	477 4TH STREET		TELEPHONE:	(530) 760-8713
CITY:	DAVIS	STATE: CA	ZIP CODE:	95616
CAPACITY:	30	CENSUS: 17	DATE:	06/28/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Liz Allewelt-Smith		TIME COMPLETED:	11:00 AM

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 June 28, 2023 Licensing Program Analysts (LPAs) Lauren Scott and Jennie Tedlos met with Director, Liz Allewelt-Smith for the purpose of an unannounced annual inspection. This year's (2023) facility Summer days and hours of operation are June 26-29th from 9AM-1PM, July 5-7th from 9AM-1PM, and July 10-13th from 9AM-1PM. Normal hours of operation are Monday, Tuesday and Wednesday from 9AM-11:45AM, and Thursday and Friday from 9AM-11AM. There were 17 children present during today's inspection. LPAs reviewed the sign in/out book and observed that the children are properly signed in. LPAs toured the facility inside and out. LPAs observed that hazardous items (disinfectants, cleaning solutions etc.) were inaccessible to children in care. LPAs reviewed staffing ratios, first aid supplies, furniture, equipment, fire drills and drinking water. LPAs observed all required forms to be posted. LPAs observed functioning carbon monoxide and smoke alarms. There are adequate toys and equipment available for children. Outdoor play area was toured and equipment appears to be in good condition. Facility provides AM snack to children in care. Food is prepared on site. Kitchen was toured at the time of inspection. All staff present during today's inspection have a fingerprint clearance. Licensee 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. *REPORT CONTINUED ON SUBSEQUENT PAGE, 809 C*

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 215-3003
LICENSING EVALUATOR NAME: Jennie Tedlos	TELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023

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

FACILITY NAME: DCCNS	FACILITY NUMBER: 573621066
	VISIT DATE: 06/28/2023

NARRATIVE

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LPAs reviewed children’s and staff files. LPAs observed health screening reports with TB test and required MMR and TDAP vaccines. At least one staff member present today has current Pediatric CPR and First Aid. LPAs observed AB1207 Mandated Reporter training certificates for all staff. The Director was reminded to renew the course every 2 years through www.mandatedreporterca.com website.

This provider is not currently providing Incidental Medical Services (IMS) services to children in care. IMS policy was reviewed and discussed at the time of inspection. 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.html

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/inspection-process.

Exit interview conducted and report was reviewed with the facility Director, Liz Allewelt-Smith. 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.

In the areas that were evaluated, no deficiencies were cited during the inspection.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 215-3003
LICENSING EVALUATOR NAME: Jennie Tedlos	TELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023

LIC809 (FAS) - (06/04)

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