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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340317948
Report Date: 02/07/2025
Date Signed: 02/07/2025 12:10:48 PM

Document Has Been Signed on 02/07/2025 12:10 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 PHILLIPS PRESCHOOLFACILITY NUMBER:
340317948
ADMINISTRATOR/
DIRECTOR:		PALMER/POWELLFACILITY TYPE:
850
ADDRESS:2930 21ST AVENUETELEPHONE:
(916) 277-6252
CITY:SACRAMENTOSTATE: CAZIP CODE:
95820
CAPACITY: 50TOTAL ENROLLED CHILDREN: 50CENSUS: 14DATE:
02/07/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Christina AlvaTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
NARRATIVE
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On Friday, February 7, 2025, Licensing Program Analysts (LPAs) Tanya Washington and Julia Maryanova met with the Facility Representative, Christina Alva for an unannounced one year annual inspection. Upon arrival, LPAs observed care and supervision of 14 children supervised by three staff. Facility is operating within the capacity and in compliance with staff child ratio on this day. Facility is operated in classroom D8 and hours of operation are 8:30 AM to 3:00 PM, Monday to Thursday, and Friday 8:30 AM to 12:15 PM. The classroom D7 was not inspected because it is occupied by a Transitional Kindergarten operated by the school district.

Licensing staff toured classroom D7 and checked the facility for safety hazards. LPAs observed the facility has a functioning smoke detector, carbon monoxide detector, first aid supplies and a working telephone. There is fully charged fire extinguisher. All of the cleaning solutions, poisons and other chemicals that are dangerous to children are stored out of children's reach. Facility has age appropriate furniture. Furniture is steady and in good repair. Facility has sufficient amount of sleeping cots and each cot was covered with a clean sheet. All toilets, hand washing facilities are in working condition with proper sanitation in place. All storage containers for solid waste are in good repair and have proper tight - fitted lids. Facility has drinking water available for children inside. LPAs observed drinking water readily available inside and outside. All food is protected from contamination, breakfast, snacks and lunch is delivered to the classroom daily. Parents receive the menu online. LPAs reviewed milk and snacks served for expiration dates, all items today were fresh and no expired items were observed. LPAs observed storage and expiration dates of medication for children, medicine observed was properly stored and not expired.

There is a waiver on file for shared playground use. LPAs toured the playground and did not observe and loose or sharp parts. The play structure is age appropriate. Licensing staff observed turf material under the play structure which is sufficient to prevent a fall injury.

LPAs reviewed the facility records. LPAs observed a daily sign in and out log. Facility has well maintained roster available on site. LPAs observed the facility has license and all of the other required documents posted at the entrance of the classroom visible for the public.
Continued on LIC809C
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Julia Maryanova
LICENSING EVALUATOR SIGNATURE: DATE: 02/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2025
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 4
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 PHILLIPS PRESCHOOL
FACILITY NUMBER: 340317948
VISIT DATE: 02/07/2025
NARRATIVE
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LPAs reviewed six children's and four staff files. LPAs observed facility has record of names, addresses and telephone numbers of each child's authorized representative. All staff present today have criminal record clearances through SCUSD school district. Facility Representative Alva has a current CPR and First Aid certification which is valid until 05/2026. LPAs observed that staff present are fully qualified and have the required ECE courses. LPAs observed a current fire drill log. Facility has an updated children roster on file. Facility is aware that all staff is required to complete Mandated Reporter Training every two years. Two out of three staff have Mandated Reporter Training certificates through Works International which is not listed as an approved alternative training agency.The training can be obtained online at www.mandatedreporterca.com.

All Child Care Centers (CCCs) that are located in buildings constructed before January 1, 2010 must have their drinking water tested for lead and post the results by January 1, 2023 and every 5 years after the date of the initial test. For a license issued on or after July 1, 2022, the CCC must have its water tested and post the results within 180 days of licensure. This facility has the water tested and submitted the result report to the department. LPAs observed Lead testing done on September 27, 2017. There was no current Lead testing available at the time of inspection.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

LPAs encouraged facility representative to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. Facility Representative can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for quarterly updates.

The copy of this report is reviewed and provided to facility representative Christina Alva . Notice of site visit is posted and shall remain posted for next 30 days.

See LIC809D for the citations that were noted during today's inspection. Appeal rights provided and explained.
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Julia Maryanova
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2025
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 02/07/2025 12:10 PM - It Cannot Be Edited


Created By: Julia Maryanova On 02/07/2025 at 11:41 AM
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 PHILLIPS PRESCHOOL
FACILITY NUMBER: 340317948

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/07/2025

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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Based on observation and 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. Licensing staff did not observe a posted Lead testing report done in the last five years.
POC Due Date: 03/07/2025
Plan of Correction
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Facility Representative will contact the administrator to see when the last test was conducted. If no result available within the last five years, facility must schedule lead testing by March 7, 2025.
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], the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. The Mandated Reporter training was obtained through Works International which is not on an approved list of alternative trainers.
POC Due Date: 03/07/2025
Plan of Correction
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Staff can take the approved training at www.mandatedreporterca.com by March 7, 2025.
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:Julia Maryanova
LICENSING EVALUATOR SIGNATURE:
DATE: 02/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/07/2025


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 02/07/2025 12:10 PM - It Cannot Be Edited


Created By: Julia Maryanova On 02/07/2025 at 11:41 AM
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 PHILLIPS PRESCHOOL
FACILITY NUMBER: 340317948

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/07/2025

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 interview and observation, the licensee did not comply with the section cited above in which poses a potential health, safety or personal rights risk to persons in care. LPAs learned that Christina Alva has been a site supervisor for more than 10 days and was provided a list of documents required to submit to the Licensing.
POC Due Date: 03/07/2025
Plan of Correction
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Facility Representative to submit required documents to LPA, Julia Maryanova via email: Julia.Maryanova@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:Julia Maryanova
LICENSING EVALUATOR SIGNATURE:
DATE: 02/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/07/2025


LIC809 (FAS) - (06/04)
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