340319008-10-8-2024-03-CC-DVAG-D9UPPZ-20241008113023

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 340319008
Report Date: 10/08/2024
Date Signed: 10/08/2024 11:30:30 AM

Document Has Been Signed on 10/08/2024 11:30 AM - 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/ DIRECTOR:	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: 6	DATE:	10/08/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:15 AM
MET WITH:	Nicole Schlie		TIME VISIT/ INSPECTION COMPLETED:	12:00 PM

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At 9:15 a.m. on Tuesday, October 8th, 2024, Licensing Program Analyst (LPA) Pa Dao Vang met with facility representative, Nicole Schlie, for the purpose of an unannounced, annual required inspection. LPA observed a census of 6 children supervised by 2 staff. Facility hours of operation are from 8:00 a.m. - 3:00 p.m., Mondays thru Fridays. Center provides breakfast and lunch for the children. The facility does not offer transportation services.

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.

LPA conducted a health and safety inspection of the classroom and restroom areas. LPA observed the following documents are posted: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, Earthquake Preparedness, Child Passenger Restraint Poster, Parent’s Notification, LIC613A Person Rights, Daily Activity Schedule, and menus. Cleaning disinfectants, medications and hazardous items are appropriately stored and inaccessible to children. Furniture and equipment are in good condition. LPA observed a drinking fountain taped off in the classroom. Director stated the drinking fountain was taped off since COVID and they’ve decided to not reopen it. Drinking water is accessible via water filter container and cups. The water bottles are transitioned with children to different environments.

LPA observed trash bins with tight fitted lids. Toileting facilities are in safe, sanitary condition. The floors appeared to be clean throughout the facility. Facility representative stated that there is no smoking, no firearms nor poisons on the premises. LPAs observed the facility’s sign in and out system. Facility has record of conducting fire drills at least every six months; last fire drill was conducted on 09/20/2024.

Continue report on LIC809-C...

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Dao Vang
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024

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: WOODLAKE STATE PRESCHOOL PORTABLE	FACILITY NUMBER: 340319008
	VISIT DATE: 10/08/2024

NARRATIVE

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Facility provides Incidental Medical Services. 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.

LPA conducted a health and safety inspection of the outdoor space. The play structure is free of loose or sharp parts with proper cushioning under it. Outdoor shade was provided by canopy, buildings, and trees.

LPA reviewed staff and children's records. LPA observed current employee rights, and documentation of the educational background, training, and/or experience. There is at least 1 staff with current CRP/First Aid certification in the facility.

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.

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 childcare 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). Facility representative stated the sink outlets in the classrooms are not used to prepare food or consume. All the food are prepared from the cafeteria. Drinking water are provided with with a water spencer and paper cups for children daily.

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

Continue report on LIC809-C...

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Dao Vang
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024

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: WOODLAKE STATE PRESCHOOL PORTABLE	FACILITY NUMBER: 340319008
	VISIT DATE: 10/08/2024

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A deficiency is being cited based on LPA’s observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22, see LIC809-D page. An exit interview was conducted with facility representative, Nicole Schlie. A copy of the appeal rights and a notice of site visit were also provided to facility representative. Notice of site visit shall remain posted for a period of 30 consecutive days.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Dao Vang
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/08/2024 11:30 AM - It Cannot Be Edited

Created By: Dao Vang On 10/08/2024 at 11:16 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: WOODLAKE STATE PRESCHOOL PORTABLE	FACILITY NUMBER: 340319008
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/08/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101216(g)(1)

Personnel Requirements

(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record reviews, the licensee did not comply with the section cited above in 1 out of 2 staff missing the LIC503 Health Screening form, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/08/2024
	Plan of Correction
1 2 3 4	Facility Representative will obtain a copy of the LIC503 for the staff's file and email a copy to LPA Vang to clear the deficiency by the POC due date.

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: 10/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024

LIC809 (FAS) - (06/04)

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