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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340319284
Report Date: 10/22/2024
Date Signed: 10/22/2024 10:40:56 AM

Document Has Been Signed on 10/22/2024 10:40 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:SKYCREST STATE PRESCHOOLFACILITY NUMBER:
340319284
ADMINISTRATOR/
DIRECTOR:		WILLIAMS, JONNAFACILITY TYPE:
850
ADDRESS:5641 MARIPOSA AVENUETELEPHONE:
(916) 867-2103
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 22DATE:
10/22/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Liqaa Azzo and Tiffany LewisTIME VISIT/
INSPECTION COMPLETED:
10:45 AM
NARRATIVE
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On October 22, 2024, Licensing Program Analyst (LPA) Stephanie Piring, met with Teacher Liqaa Azzo for an unannounced case management inspection regarding a self reported incident which occurred on 10/15/2024. Upon arrival LPA observed care and supervision of 22 children supervised by 3 staff.

It was reported that on 10/15/2024 approximately between 8:00 AM and 8:30AM , during morning drop off, a mother reported that she dropped off her child and the child was crying. the mother reported that she took the child to teacher Liqaa and said goodbye. The mother reported the child ran out of the classroom to her and the mother brought her back to the classroom.

LPA conducted interviews with staff #1 whom is the lead teacher. LPA learned that the child usually cries and does not want to leave her mother at drop off. Liqaa Azzo shared that the mother normally says Ok, I'm leaving to notify staff of her departure. Teacher states that on this day, the mother did not notify any teachers of her departure. Teacher also demonstrated to LPA that the door shuts softly and does not completely latch. Teacher demonstrated having to slam the door shut to get it to close and latch completely. Teacher also shared that both herself and staff 2 have made multiple request to get the door latch fixed prior to the incident. Following the incident, Teacher stays at the door to greet families during drop off and to ensure the door is completely closed and latched.

Based on interview, a Title 22 Deficiency has been issued on the attached LIC809-D page. The Facility Representative was informed that this report dated 10/22/24 documents one Type A citation and must be posted for parental review for 30 consecutive days. The facility must also provide a copy of this licensing report to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in each child's file for verification. Exit interview was conducted and a copy of this report was given to the Facility Representative Tiffany Lewis . Notice of site was given and must remain posted for parental review for 30 days. Appeal rights were provided.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Stephanie Piring
LICENSING EVALUATOR SIGNATURE: DATE: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/22/2024
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 10/22/2024 10:40 AM - It Cannot Be Edited


Created By: Stephanie Piring On 10/22/2024 at 10:15 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: SKYCREST STATE PRESCHOOL
FACILITY NUMBER: 340319284

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/23/2024
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision (a)The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time...shall include visual observation.
This requirement is not met as evidenced by:
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Facility has already put in place a staff memebr standing at the door to greet families and ensure that the doorway is supervised and secure at all times. Facility will get the door latched fixed to shut properly. Facility Representative has ensured a request has been out in. Facility will notify LPA once the door is fixed.
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Based on interview, the facility did not comply with the section cited above as a child left the classroom without supervision of staff for approximately 1 minute, which poses an immediate health, safety, or personal rights risk to persons in care. Facility self reported and submitted a written Unusual Incident Report (UIR) to the department.
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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:Natalie Dunaway
LICENSING EVALUATOR NAME:Stephanie Piring
LICENSING EVALUATOR SIGNATURE:
DATE: 10/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/22/2024


LIC809 (FAS) - (06/04)
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