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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 033616425
Report Date: 01/13/2023
Date Signed: 01/13/2023 12:13:23 PM

Document Has Been Signed on 01/13/2023 12:13 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 SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:IONE-AMADOR TUOLUMNE COMMUNITY ACTION AGENCYFACILITY NUMBER:
033616425
ADMINISTRATOR:BUCHANAN, SANDYFACILITY TYPE:
830
ADDRESS:108 W. MARLETTE STREETTELEPHONE:
(209) 274-0395
CITY:IONESTATE: CAZIP CODE:
95640
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 6DATE:
01/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Education Manager- Deborah Taylor TIME COMPLETED:
12:30 PM
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Licensing Program Analysts (LPA’s) Mariya Melnichuk and Lauren Scott met with Education Manager, Deborah Taylor for the purpose of an unannounced Annual/Random inspection. There were six children present during today's inspection. LPA's toured the facility inside and out. Facility provides breakfast, lunch and snack which is cooked onsite. Facility days and hours of operation are Monday-Friday from 7:55 AM to 2:05 PM.

LPA's reviewed care and supervision of children, staffing ratios, medications and first aid supplies, furniture, equipment, fire drills and drinking water. LPA observed all required forms to be posted. There were cribs available for each infant under 12 months old and cots available for infants over 12 months old. There are needs and services plans for each infant and toddler enrolled. LPA's observed proper storage of refrigerated bottles which were dated and labeled with children's names. LPA's observed that hazardous items (disinfectants, cleaning solutions etc.) were inaccessible to children in care.LPA observed a changing table within arm's reach of the sink. There are adequate toys and equipment available for children. Outdoor play area was toured, the play structure for the toddlers appeared to be in good repair, there is sufficient cushioning (foam) under the play structure to prevent the fall.

LPA's reviewed the sign in/out book and observed that the children are properly signed in/out. All staff present during today's inspection have a fingerprint clearance. 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.


Report continues on 809-C.
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Mariya Melnichuk
LICENSING EVALUATOR SIGNATURE: DATE: 01/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/13/2023
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 SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: IONE-AMADOR TUOLUMNE COMMUNITY ACTION AGENCY
FACILITY NUMBER: 033616425
VISIT DATE: 01/13/2023
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Children and staff files were reviewed. Each child's file contained an emergency card and other required documents. LPA's observed required documents, including health screening reports with TB test and required MMR and TDAP vaccines, for staff. At least one staff member present today has current Pediatric CPR and First Aid. LPA 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.
Incidental Medical Services (IMS) policy was discussed. Facility has a plan in place. 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.

LPA's discussed the safe sleep regulations with Facility Representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Facility Representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

LPA's observed 15min infant napping logs for infants 24 months and under. LPA discussed the LIC 9227 Individual Sleeping Plan for infants under 12 months during today's inspection, per safe sleep regulations.



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 Representative. 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.
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Mariya Melnichuk
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2023
LIC809 (FAS) - (06/04)
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