<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340306416
Report Date: 06/01/2023
Date Signed: 06/01/2023 12:19:34 PM

Document Has Been Signed on 06/01/2023 12:19 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
RIVER CITY (SACTO)CC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:ELDER CREEK CHILDREN'S CENTERFACILITY NUMBER:
340306416
ADMINISTRATOR:DORROUGH, FRANCHINEFACILITY TYPE:
850
ADDRESS:7800 LEMON HILL AVETELEPHONE:
(916) 454-8194
CITY:SACRAMENTOSTATE: CAZIP CODE:
95824
CAPACITY: 101TOTAL ENROLLED CHILDREN: 101CENSUS: 20DATE:
06/01/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Irina ZolnikovTIME COMPLETED:
12:30 PM
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 1, 2023, Licensing Program Analysts (LPAs) Amanda Sutter and Pa Dao Vang met with lead teacher Irina Zolnikov for the purpose of clearing the deficiencies that were cited on 4/27/2023. Upon arrival, LPAs observed 20 children supervised by 3 staff.

LPAs cleared the citation HSC 1596.954 for a missing carbon monoxide detector. LPAs observed a functioning carbon monoxide detector installed in the nap area of the classroom.

LPAs cleared the citation HSC 1596.8662(b)(1) for staff files missing mandated reporter certificates. Each staff member present has a current mandated reporter certificate.

LPAs cleared the citation CCR 101216(f) for missing CPR/First Aid certification. There is at least one staff member present who has a current EMSA approved CPR/First Aid certification.

LPA Sutter has not received paperwork for a new director at the facility. No staff member present has a current EMSA approved Preventative Health and Safety Training certificate, and LPA has not observed an updated Emergency Disaster Plan (LIC610).

LPAs reviewed this report with Lead Teacher Irina Zolnikov. Based on the inspection, one Type B citation has been issued. Staff was provided with a notice of site visit that must be posted for 30 days. Appeal rights were provided.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Amanda Sutter
LICENSING EVALUATOR SIGNATURE: DATE: 06/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/01/2023
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 2
Document Has Been Signed on 06/01/2023 12:19 PM - It Cannot Be Edited


Created By: Amanda Sutter On 06/01/2023 at 12:07 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: ELDER CREEK CHILDREN'S CENTER
FACILITY NUMBER: 340306416

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/16/2023
Section Cited
CCR
101215.1(b)

1
2
3
4
5
6
7
101215.1 Child Care Center Directors Qualifications and Duties (b) All child care centers shall have a director.

This requirement is not met as evidenced by:
1
2
3
4
5
6
7
LPA will receive a director packet by date listed above. LPA did not observe an updated LIC610 or staff member with a Preventative Health and Safety Training at the facility.
8
9
10
11
12
13
14
Based on observation, LPA did not observe a fully qualified director at the facility, which poses a potential health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: 06/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/01/2023


LIC809 (FAS) - (06/04)
Page: 2 of 2