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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340316146
Report Date: 08/29/2024
Date Signed: 09/17/2024 01:16:32 PM

Document Has Been Signed on 09/17/2024 01:16 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:
08/29/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:15 AM
MET WITH:Sia LorTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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On 9/17/2024, Licensing Program Analyst (LPA) Amanda Sutter met with Lead Teacher Sia for the purpose of a case management inspection regarding lead testing, and to clear deficiencies cited at the annual inspection on 6/6/2024. Upon arrival, LPAs observed three staff supervising fifteen children.

During the annual inspection on 6/6/2024, two type B citations were issued. Plans of Correction (POCs) were originally due 6/28/2024, however, the facility was closed from 6/13/2024 to 9/3/2024 for summer break.

LPA cleared the citation CCR 101239(o)(1) for the sharp enamel on the playground stairs that had created a tripping hazard. LPA observed that the enamel had been removed and the stairs had been painted over. LPA reviewed reporting requirements with Lead Teacher.

The facility also received a citation for failure to notify the department of a change in director. LPA received the following documents for Lead Teacher Sia Lor on 6/6/2024: CPR/First Aid certification, Mandated Reporter certificate, Site Supervisor permit, LIC308, LIC500, and LIC610. The following documents still need to be submitted in order to qualify Sia Lor: Child Care Center Operations and Record Keeping Orientation Certificate, Preventative Health and Safety certificate or proof of coursework, and LIC501.





PAGE 1. CONTINUED ON LIC812-C
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Amanda Sutter
LICENSING EVALUATOR SIGNATURE: DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/17/2024
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 09/17/2024 01:16 PM - It Cannot Be Edited


Created By: Amanda Sutter On 09/17/2024 at 12:14 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: 08/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/18/2024
Section Cited

101700.3(b)(1)

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101700.3 California Lead Action Level at Child Care Centers (b) Testing results with ... (1) A ... values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.

This requirement is not met as evidenced by:
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SCUSD will provide LPA with clarity regarding the 'B' tap. If the 'B' tap is the one inside the classroom, the facility has remediated the issue by removing the fountain. If the 'B' tap is the fountian on the playground, the facility will either cap off the fountain or get it re-tested.
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Based on record review, one faucets tested exceeded the allowed 5.5 ppb, which poses/posed a potential health, safety or personal rights risk to persons in care.
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Type B
11/01/2024
Section Cited
CCR101212(b)

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101212 Reporting Requirements (b) The name of the child care center director...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:
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LPA will receive a completed "Director" file for Site Supervisor by date listed above.
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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.
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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: 09/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/17/2024


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: 08/29/2024
NARRATIVE
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On 12/27/2022, the facility tested water samples for lead. One water sampled indicated an Action Level Exceedance (ALE). There are three water sources at the facility: a drinking fountain connected to the sink on the South wall in the classroom, a sink on the right-hand wall next to the hallway in the classroom, and a drinking fountain outside on the playground. LPA received photographs and a facility sketch that indicate which taps were tested. The outlet labeled 'A' on the facility sketch and in the photographs correlates to the drinking fountain on the South wall in the classroom. The facility sketch labels the outside drinking fountain as 'B', while the photographs show the indoor drinking fountain near the hallway as 'B'. Lead Teacher stated she is unaware which of these taps is 'B.'

On 6/17/2024, the facility was notified that water levels were in exceedance of 5.5 parts per billion in the locations that were tested. LPA was told by Lead Teacher that the drinking fountain on the right-hand wall near the hallway is not used by children. During today's inspection, LPA observed that the fountain had been removed and the pipe had been capped off at the wall. Lead Teacher stated that the outdoor fountain had been used by children. The fountain is covered by a metal grate with a lock. Staff use a pitcher with cups to provide water to children outside.

LPA informed Sia Lor of Grant funding for testing and remediation is available referenced from Provider Information Notice PIN 21-04-CCP.

A notice of site visit was given and must remain posted for 30 days. Based on the inspection, two type B citations have been issued. Appeal right were provided. Exit interview conducted and report was reviewed with Lead Teacher Sia Lor.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Amanda Sutter
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024
LIC809 (FAS) - (06/04)
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