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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313623960
Report Date: 05/10/2024
Date Signed: 05/10/2024 08:59:50 AM


Document Has Been Signed on 05/10/2024 08:59 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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:KIDZCOMMUNITY EARLY LEARNING CENTER, ADELANTEFACILITY NUMBER:
313623960
ADMINISTRATOR:PARK,GINGERFACILITY TYPE:
830
ADDRESS:350 ATLANTIC STREETTELEPHONE:
(916) 782-3155
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY:16CENSUS: 8DATE:
05/10/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Ginger Park - Site SupervisorTIME COMPLETED:
09:15 AM
NARRATIVE
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An unannounced inspection was conducted today by Licensing Program Analyst Owens. LPA Owens met with Ginger Park, Site Supervisor. Present at time of inspection were 3 infants , 5 toddlers and 5 staff.

The purpose of the inspection is to address an unusual incident that was self reported to Licensing by the facility. On 2/1/2023 a staff mishandled a child because the child was having a tantrum; the child was not injured.

The following is cited per Title 22 Div. 12 of the CCR: (see page 2)
Copy of Appeal Rights left with Center Representative.

LPA Owens informed facility representative, Ginger Park that this report dated 5/10/2024
document(s) Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

LPA Owens informed facility representative to provide a copy of this licensing report dated 5/10/2024 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed
Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. LIC 9224 was given and explained to director at time of inspection.
Notice of site given.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Katrina OwensTELEPHONE: (916) 879-1175
LICENSING EVALUATOR SIGNATURE:
DATE: 05/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/10/2024
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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Document Has Been Signed on 05/10/2024 08:59 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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


FACILITY NAME: KIDZCOMMUNITY EARLY LEARNING CENTER, ADELANTE
FACILITY NUMBER: 313623960

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/10/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/10/2024
Section Cited
CCR
101223(a)(3)

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PERSONAL RIGHTS:
To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to:
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The facility self reported the unusual incident to CCLD. The staff was terminated on 2/5/2024. LPA Owens confirmed the termination of the staff at time of inspection. She stated additional training was given to other staff on children personal rights.
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This requirement was not met: a staff turned a child upside down because he was having a tantrum. The child was not injured. This is an immediate risk to a child.
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Deficiency cleared at time of inspection.

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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: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Katrina OwensTELEPHONE: (916) 879-1175
LICENSING EVALUATOR SIGNATURE:
DATE: 05/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/10/2024
LIC809 (FAS) - (06/04)
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