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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340306418
Report Date: 11/16/2023
Date Signed: 11/16/2023 02:42:11 PM

Document Has Been Signed on 11/16/2023 02:42 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:SHILOH ARMS CHILD DEVELOPMENT CENTERFACILITY NUMBER:
340306418
ADMINISTRATOR:ROWENA CAMILLERFACILITY TYPE:
850
ADDRESS:3949 23RD AVENUETELEPHONE:
(916) 453-1309
CITY:SACRAMENTOSTATE: CAZIP CODE:
95820
CAPACITY: 46TOTAL ENROLLED CHILDREN: 19CENSUS: 10DATE:
11/16/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
12:39 PM
MET WITH:Rowena CamillerTIME COMPLETED:
02:20 PM
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On Thursday, November 16, 2023, Licensing Program Analyst (LPA) Tanya Washington met with Facility Representative (FR), Rowena Camiller for the purpose of an unannounced required annual inspection. LPA observed ten napping children supervised by four staff. The facility hours of operation are Monday through Friday from 7:00 AM to 5:30 PM.

LPA toured all classroom spaces, restrooms, and outdoor play area. LPA observed the following documents are posted: License, Emergency Disaster Plan, Earthquake Preparedness, Personal Rights, Parents' Rights Poster, menu, and seat belt law. Cleaning disinfectants, medications and hazardous items are appropriately stored and inaccessible to children. Facility Representative stated there are no poisons or firearms on the premises. Furniture and equipment are in good condition, and toileting facilities are in safe, sanitary and operating condition. The program provides breakfast, lunch, and PM snack. All meals are prepared on site. LPA observed all food protected against contamination and no expired foods were observed in the kitchen.

LPA observed trash bins with tight fitted lids. Drinking water is readily available to children both indoors and outdoors. LPA observed the facility’s paper sign in and out system. Facility Representative did not have a record of a fire drill log during the inspection. Playground equipment and surfaces are free of loose or sharp parts. There is sufficient equipment and toys, and there are shaded areas supplied by shade structures.

Four staff and five children's records were reviewed. All children's files appeared to be complete. Four out of four staff did not have a current Mandated Reporter Training, FR was informed that staff can renew their training online at www.mandatedreporterca.com or through one of the approved vendors (list of vendors available online at www.cdss.ca.gov . There is at least one staff member present with a current CPR certificate. LPA observed a functional carbon monoxide detector.

PAGE 1. REPORT CONTINUES ON LIC809-C

SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: SHILOH ARMS CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 340306418
VISIT DATE: 11/16/2023
NARRATIVE
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Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For childcare center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP). Facility is not in compliance with this requirement during today's inspection.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/.

Facility Representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

PAGE 2. REPORT CONTINUES ON LIC809-C
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023
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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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: SHILOH ARMS CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 340306418
VISIT DATE: 11/16/2023
NARRATIVE
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LPA confirmed that the annual fees are current. LPA informed the Facility Representative of the recent regional office relocation and provided updated personal and parent's rights forms and postings.

Facility Representative was informed of the www.mychildcareplan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.



During today’s inspection three Type B deficiencies are cited on the following LIC809D pages. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Facility Representative Rowena Camiller. Appeal rights are provided and discussed.
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/16/2023 02:42 PM - It Cannot Be Edited


Created By: Tanya Washington On 11/16/2023 at 01:24 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: SHILOH ARMS CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 340306418

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/16/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on interview, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/18/2023
Plan of Correction
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Facility Representative stated that she will schedule lead testing before POC date of 12/18/2023.
Type B
Section Cited
CCR
101174(d)(2)
Disaster and Mass Casualty Plan
(d) Disaster drills shall be conducted at least every six months. (2) The drills shall be documented. This documentation shall be kept in the child care center for at least one year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. FR stated that staff who is in charge of keeping record of fire drills is on vacation and she did not have access to their files.
POC Due Date: 12/18/2023
Plan of Correction
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FR will submit proof of logged fire drill to LPA Washington by e-mail by POC date of 12/18/2023. LPA advised the FR to keep the fire drill log either posted or in a accessible area for the Facility Representative.
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:Amanda Blesi
LICENSING EVALUATOR NAME:Tanya Washington
LICENSING EVALUATOR SIGNATURE:
DATE: 11/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/16/2023


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 11/16/2023 02:42 PM - It Cannot Be Edited


Created By: Tanya Washington On 11/16/2023 at 01:24 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: SHILOH ARMS CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 340306418

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/16/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, four out of four staff did not have a current Mandated Reporter Trianing, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/18/2023
Plan of Correction
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Facility Representative will ensure all staff complete the required training by POC date of 12/18/2023. FR can submit proof of correction to LPA Washington via e-mail tanya.washington@dss.ca.gov
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Amanda Blesi
LICENSING EVALUATOR NAME:Tanya Washington
LICENSING EVALUATOR SIGNATURE:
DATE: 11/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/16/2023


LIC809 (FAS) - (06/04)
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