340318128-4-7-2023-03-CC-MGON-CQNS7W-20230407133812

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 340318128
Report Date: 04/07/2023
Date Signed: 04/07/2023 01:38:26 PM

Document Has Been Signed on 04/07/2023 01:38 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME:	FLORIN ELEMENTARY SCHOOL		FACILITY NUMBER:	340318128
ADMINISTRATOR:	PASLEY, ROBERT		FACILITY TYPE:	850
ADDRESS:	7300 KARA DRIVE		TELEPHONE:	(916) 383-0530
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95828
CAPACITY: 48	TOTAL ENROLLED CHILDREN: 48	CENSUS: 13	DATE:	04/07/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Willbert Villarta		TIME COMPLETED:	01:45 PM

NARRATIVE

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On Friday April 7th, 2023, Licensing Program Analysts (LPAs) Mandie Goodwin and Amanda Sutter met with Principal Willbert Vallarta and Lead teacher, Norma Cabral, for the purpose of an unannounced 1 year required inspection, and inspection of lead outlets. Staff stated that the administrator listed on the facility profile is no longer employed at the facility and the principal now is Willbert Villarta. Facility hours of operation in classroom A-1 are Monday through Friday from 8:00 AM to 11:00 AM (for AM group) and 12:00 PM to 2:30 PM (for PM group). Facility hours of operation in the classroom A-4 are Monday through Friday from 8:00 AM to 2:30 PM. LPAs toured the facility, at which time a census of 30 preschool children supervised by 5 staff across the two classrooms were observed.

A health and safety inspection were conducted in the classrooms, restrooms, food service areas, and outdoor play areas. LPAs observed the following documents are posted: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, required publications, menus, and daily schedules. Cleaning disinfectants and hazardous items are appropriately stored and inaccessible to children. Medications are stored out of reach and inaccessible to children. Furniture and equipment are in good condition, and toileting facilities are in sanitary, and operating condition. Bins for solid waste have tight fitting lids. The floors appeared clean throughout the facility. LPAs observed smoke and carbon monoxide detectors. LPAs observed a current roster, sign in and out sheets, and a fire drill log. Per fire drill log the last fire drill was 3/23/23.

Children have access to water using water jugs indoors and drinking fountains outdoors. Playground equipment and surfaces are free of loose or sharp parts. Facility has a shared playground space waiver on file. LPAs observed sufficient cushioning of bark and grass. Outdoor shade is provided by canopies, trees, and sides of buildings. There are no firearms or bodies of water on the premises. Teacher stated there are no poisons on the premises.

(Continued on 809-C)

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Mandie Goodwin
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2023

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 04/07/2023 01:38 PM - It Cannot Be Edited

Created By: Mandie Goodwin On 04/07/2023 at 12:28 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
, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: FLORIN ELEMENTARY SCHOOL	FACILITY NUMBER: 340318128
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/07/2023

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
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above by failing to report a change of on-site director, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/05/2023
	Plan of Correction
1 2 3 4	Facility will designate an onsite director and submit a director packet to licensing by POC date.

Type B

Section Cited

10700(b)(1)

WD 101700(b)(1) California Lead Action Level at Child Care Centers (b) Testing results with ... (1) ... "values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, one faucet tested exceeding the allowed 5.5ppb, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/05/2023
	Plan of Correction
1 2 3 4	Facility will replace and retest the faucet.

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:

Mandie Goodwin

LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2023

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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: FLORIN ELEMENTARY SCHOOL	FACILITY NUMBER: 340318128
	VISIT DATE: 04/07/2023

NARRATIVE

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On 3/17/2023, a water sample taken from a sink inside the classroom A1 was collected and tested for the presence of lead. The test results indicated lead values of 5.9 parts per billion (pbb), exceeding the recommended 5.5 pbb. The sink was previously used for consumption. When the facility was notified of the test results, they immediately made the sink inaccessible to children by bagging and taping off the faucets and providing water from a delivery service water.

LPAs reviewed staff files. At least one staff member present today has current Pediatric CPR and First Aid certification. LPAs observed immunization records and documentation of the educational background, training, and/or experience. Upon review, all staff members had current mandated reporter trainings. LPAs advised AB 1207 Mandated Reporter training must be renewed every two years.

A sample of 5 children's records were reviewed. Each child's file contained an emergency card, consent for emergency medical treatment, health history, a record of immunization’s and notifications of children’s and parent’s rights.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

This facility provides Incidental Medical Services – IMS. LPAs reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Mandie Goodwin
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2023

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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: FLORIN ELEMENTARY SCHOOL	FACILITY NUMBER: 340318128
	VISIT DATE: 04/07/2023

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In the areas that were evaluated, two type B deficiencies were observed at the time of the visit and are cited on LIC 809-D. Appeal rights were provided. Exit interview was conducted and report was reviewed with the representative Willbert Villarta and teacher Norma Calbra. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Mandie Goodwin
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2023

LIC809 (FAS) - (06/04)

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