340319008-8-1-2023-03-CC-DVAG-CUAR5U-20230801124344

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 340319008
Report Date: 08/01/2023
Date Signed: 08/01/2023 12:43:58 PM

Document Has Been Signed on 08/01/2023 12:43 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:	WOODLAKE STATE PRESCHOOL PORTABLE		FACILITY NUMBER:	340319008
ADMINISTRATOR:	FLORES-ACOSTA, REBECCA		FACILITY TYPE:	850
ADDRESS:	700 SOUTHGATE ROAD		TELEPHONE:	(916) 566-2755
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95815
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 24	CENSUS: 0	DATE:	08/01/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Flores-Acosta, Rebecca		TIME COMPLETED:	01:00 PM

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LPAs Pa Dao Vang and Gagandeep Singh met with Site Supervisor Rebecca Flores-Acosta, for the purpose of an unannounced 1 year required inspection. This facility is located on Woodlake Elementary School grounds in Portable 8. LPA toured the facility with no children present. Facility representer stated that the Center is currently closed and will open on 8/17/23. All individuals subject to criminal background review have obtained clearance. LPA will print an updated Notification of Parent's Rights with current License Office address.

A health and safety inspection was conducted in the classrooms, restrooms, garden 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 schedule. Cleaning disinfectants and hazardous items are appropriately stored and inaccessible to children. There were no medications stored at facility at this time. 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 working smoke alarm and fire extinguisher with 2A-10-BC. LPA observed that children are signed in and out of the facility using a digital application called Learning Genie.

Children have access to water indoors and outdoors using a water pitcher and paper cups that are transported with children, during transitions. Playground equipment and surfaces are free of loose or sharp parts. LPAs observed sufficient cushioning under the play structure. Outdoor shade is provided by canopies. There are no firearms or bodies of water on the premises. Facility representative stated there are no poisons on the premises.

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SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Dao Vang
LICENSING EVALUATOR SIGNATURE:	DATE: 08/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2023

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 08/01/2023 12:43 PM - It Cannot Be Edited

Created By: Dao Vang On 08/01/2023 at 12:20 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: WOODLAKE STATE PRESCHOOL PORTABLE	FACILITY NUMBER: 340319008
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/01/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.954

Licensure Requirements

Every licensed child day care center shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above as LPAs didn't observe an independent carbon monoxide detector, in which posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/17/2023
	Plan of Correction
1 2 3 4	Facility represetative agree to install carbon monoxide in the classroom before school reopends.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Dao Vang

LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2023

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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: WOODLAKE STATE PRESCHOOL PORTABLE	FACILITY NUMBER: 340319008
	VISIT DATE: 08/01/2023

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LPAs reviewed staff files. At least one staff member present today has current Pediatric CPR and First Aid certification in which will expire on 06/2025. LPAs observed immunization records and documentation of the educational background, training, and/or experience. Upon review, facility representative have current mandated reporter training in which will expire on 08/7/2024. LPAs advised AB 1207 Mandated Reporter training must be renewed every two years and can be renewed at www.mandatedreporterca.com.

Facility have a record of conducting fire drills at least every six months with the last log on 06/11/2023.

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.

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.

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 child care 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).

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SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Dao Vang
LICENSING EVALUATOR SIGNATURE:	DATE: 08/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2023

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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: WOODLAKE STATE PRESCHOOL PORTABLE	FACILITY NUMBER: 340319008
	VISIT DATE: 08/01/2023

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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) 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 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.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with representative Rebecca Flores- Acosta..

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Dao Vang
LICENSING EVALUATOR SIGNATURE:	DATE: 08/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2023

LIC809 (FAS) - (06/04)

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