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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340316146
Report Date: 06/06/2024
Date Signed: 06/06/2024 12:54:52 PM

Document Has Been Signed on 06/06/2024 12:54 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:ETHEL I. BAKER PRESCHOOLFACILITY NUMBER:
340316146
ADMINISTRATOR/
DIRECTOR:
MILLER, MELISSAFACILITY TYPE:
850
ADDRESS:5717 LAURINE WAY, ROOM 29TELEPHONE:
(916) 395-4562
CITY:SACRAMENTOSTATE: CAZIP CODE:
95824
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 15DATE:
06/06/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Sia LorTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
NARRATIVE
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On Thursday, June 6, 2024, Licensing Program Analyst (LPA) Amanda Sutter met with Site Supervisor Sia Lor for the purpose of an unannounced required annual inspection. LPA observed 15 children supervised by three staff. All individuals subject to criminal background review have obtained a criminal record clearance. The facility hours of operation are Monday through Thursday from 8:00 AM to 2:30 PM, and Friday from 8:00 AM to 11:45 PM.

LPA toured classroom space, restrooms, and outdoor play area. LPA observed the following documents are posted: License, Parents' Rights Poster, Child Personal Rights, Seat Belt Law, Menu, Daily Schedule, Earthquake Preparedness Checklist, Shared Outdoor Space Waiver, and Emergency Disaster Plan. LPA observed a functional carbon monoxide detector. Cleaning disinfectants and hazardous items are appropriately stored and inaccessible to children. Director 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 provides breakfast, lunch, and a snack.

LPA observed trash bins with tight fitted lids. The facility uses both electronic and paper sign in and out system. Facility has record of conducting fire drills at least every six months. The last fire drill was conducted on May 9, 2024. LPA observed that the enamel covering on the metal play structure steps had worn away on the top of the steps and was protruding and sharp on the sides of the steps. LPA observed five incident reports showing that children had gotten injured due to tripping on the steps. LPA observed bark under the equipment. There are sufficient equipment and toys, and shaded areas are supplied by awnings. Drinking water is readily available to children both indoors and outdoors. Director stated that children use drinking fountains outdoors and LPA observed the children’s personal water bottles outdoor as well.

One staff and four children's records were reviewed. Both children’s files and staff files were observed to be complete. There is at least one staff member present with a current CPR certificate. PAGE 1. REPORT CONTINUES ON LIC809-C

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Amanda Sutter
LICENSING EVALUATOR SIGNATURE: DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/06/2024
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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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: ETHEL I. BAKER PRESCHOOL
FACILITY NUMBER: 340316146
VISIT DATE: 06/06/2024
NARRATIVE
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LPA referred facility representative to the Department website for lead: https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information

LPA discussed the safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

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-care-centers/.

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.

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

During today’s inspection, two Type B deficiencies were observed. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Site Supervisor Sia Lor. Appeal rights were provided.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Amanda Sutter
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/06/2024 12:54 PM - It Cannot Be Edited


Created By: Amanda Sutter On 06/06/2024 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: ETHEL I. BAKER PRESCHOOL

FACILITY NUMBER: 340316146

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 06/06/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101212(b)
Reporting Requirements
(b) The name of the child care center director, and any fully qualified teacher(s) designated to act in the child care center director's absence, shall be reported to the Department within 10 days of a change of child care center director or designee(s).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that LPA was not notified of a change in Site Supervisor, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/28/2024
Plan of Correction
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LPA will receive a completed "Director" file for Site Supervisor by date listed above.
Type B
Section Cited
CCR
101239(o)(1)
(o) Playground equipment ...
(1) Equipment shall be maintained in a safe condition, free of sharp, loose or pointed parts.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, there is sharp enamel on the playground stairs, which have led to numerous child injuries and pose a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/28/2024
Plan of Correction
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Playground stairs will be fixed in a way that no longer poses a potential health and safety risk to children. Photos will be submitted to LPA by date listed above.
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: 06/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/06/2024


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