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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 054500737
Report Date: 08/15/2023
Date Signed: 08/15/2023 05:07:07 PM

Document Has Been Signed on 08/15/2023 05:07 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:SARAH KELLY'S CHILD CARE & LEARNING CENTERFACILITY NUMBER:
054500737
ADMINISTRATOR:SAMANTHA ARTIAGAFACILITY TYPE:
830
ADDRESS:4423 SIX MILE ROADTELEPHONE:
(209) 263-2295
CITY:ANGELS CAMPSTATE: CAZIP CODE:
95222
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 16DATE:
08/15/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Owner, Sarah KellyTIME COMPLETED:
05:30 PM
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On 08/15/2023, Licensing Program Analyst (LPA) Tobias Lake arrived at the facility for a complaint investigation. LPA toured the facility and each classroom. During the investigation, LPA discovered an uncleared adult working as a staff in the infant classroom that is not background checked. Record review and an interview with the Licensee, Sarah Kelly, confirmed the staff is not cleared and has been working for the previous five working days.

A Title 22 deficiency is cited on LIC 809-D. Licensee acknowledges, that for TYPE A DEFICIENCIES ONLY upon receipt, Licensee shall post LIC 809-D with Type A deficiency 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. LIC9224 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. LIC9224 and Appeal Rights were provided.

An exit interview was conducted. The Notice of Site Visit (LIC 9213) was posted where the parent/guardian of children enter and exit the facility. The Notice of Site Visit (LIC 9213) must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Tobias Lake
LICENSING EVALUATOR SIGNATURE: DATE: 08/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2023
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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Document Has Been Signed on 08/15/2023 05:07 PM - It Cannot Be Edited


Created By: Tobias Lake On 08/15/2023 at 01:40 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SARAH KELLY'S CHILD CARE & LEARNING CENTER
FACILITY NUMBER: 054500737

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/30/2023
Section Cited
CCR
101170(e)(1)

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101170(e)(1) Criminal Record Clearance. (e) All individuals subject to a criminal record review... shall prior to working... in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department. This requirement was not met as evidenced by:
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Licensee will ensure uncleared adult does not resume work until they have a verified background clearance. Licensee will submit a copy of the live scan form receipt to LPA by
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Based on record review and interview, it was determined that a staff did not have a criminal record exemption approved but was working in the facility for the last five days which poses an immediate Health, Safety, or Personal Rights risk to persons 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:Karyn Guerra
LICENSING EVALUATOR NAME:Tobias Lake
LICENSING EVALUATOR SIGNATURE:
DATE: 08/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/15/2023


LIC809 (FAS) - (06/04)
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