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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340306392
Report Date: 01/09/2025
Date Signed: 01/09/2025 02:00:54 PM

Document Has Been Signed on 01/09/2025 02:00 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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:ASSOCIATED STUDENTS CSUS CHILDREN'S CENTERFACILITY NUMBER:
340306392
ADMINISTRATOR/
DIRECTOR:		VELTE, SHERRYFACILITY TYPE:
850
ADDRESS:6000 J STREETTELEPHONE:
(916) 278-6216
CITY:SACRAMENTOSTATE: CAZIP CODE:
95819
CAPACITY: 126TOTAL ENROLLED CHILDREN: 126CENSUS: 74DATE:
01/09/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:15 AM
MET WITH:Sherry VelteTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
NARRATIVE
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On January 9, 2025, Licensing Program Analyst (LPA) Amanda Sutter met with Director Sherry Velte for an unannounced Case Management inspection. LPA observed 74 children supervised by 27 staff.

On November 21, 2024, Director submitted an Unusual Incident Report (UIR) that stated that a child (C1) was served a snack item on 11/18/2024 that he was allergic to. After being picked up by his parent, C1 began vomiting and had diarrhea, and was taken to the hospital for IV fluids. Director stated that as of today, the child is doing much better and has returned to the center.

LPA interviewed Staff 1 (S1), who stated that at the time of the incident, she was sitting with the children for meal time. She had requested the child’s lunch bag from another staff person. The child’s lunch bag was labeled and the wrong lunch bag was grabbed. The child ate an animal cracker cookie, and then a staff member noticed that his lunch was still in the refrigerator. The child was then provided the correct lunch bag. LPA asked if S1 knew that the child had allergies and she stated that at the time, children’s meal preferences and allergies were written on a piece of paper taped to the table. In regards to this child, the notice only specified that C1 brought his own lunch. LPA asked if the Associate Teacher in the classroom at the time (S2) was aware of C1’s allergies, and S1 stated that she did not know. S2 no longer works at the facility. Director stated that S2 was aware of the child's allergies.

Since the incident, Director has implemented a new food allergy policy. Children with food allergies have their lunches kept separate from other children’s lunches. Both student staff and their supervisors must sign off verifying that the child has been provided the correct meal before it is given to them. LPA observed this paperwork and was provided a copy.


PAGE 1. CONTINUED ON LIC812-C
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Amanda Sutter
LICENSING EVALUATOR SIGNATURE: DATE: 01/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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: ASSOCIATED STUDENTS CSUS CHILDREN'S CENTER
FACILITY NUMBER: 340306392
VISIT DATE: 01/09/2025
NARRATIVE
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This is an amended report.

Based on the inspection, one Title 22 Deficiency has been issued on the attached LIC 809-D. The director was informed that this report dated 1/9/2025 documents one Type A citation which shall be posted for 30 consecutive days. The director shall also provide a copy of this licensing report 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. Director has been provided with appeal rights. Exit interview conducted and report was reviewed with Director Sherry Velte. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Amanda Sutter
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/09/2025 02:00 PM - It Cannot Be Edited


Created By: Amanda Sutter On 01/09/2025 at 01:25 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: ASSOCIATED STUDENTS CSUS CHILDREN'S CENTER
FACILITY NUMBER: 340306392

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/10/2025
Section Cited
CCR
101227(a)(7)(B)

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101227 Food Services (B) A child shall not be served any food to which the child's record indicates he/she has an allergy.

This regulation was not met as evidenced by:
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The facility has changed their proceedure for children with allergies. LPA observed verification forms for each child with allergies. Both staff and their supervisor must verify that children with allergies are provided the correct food at each mealtime. Food for children with allergies is stored separately.
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Based on interview, LPA learned that a child was provided food they were allergic to, 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:Seychelle De Luca
LICENSING EVALUATOR NAME:Amanda Sutter
LICENSING EVALUATOR SIGNATURE:
DATE: 01/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2025


LIC809 (FAS) - (06/04)
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