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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343604550
Report Date: 01/12/2024
Date Signed: 01/12/2024 12:08:31 PM

Document Has Been Signed on 01/12/2024 12:08 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:SKILLS CHILDREN'S CENTERFACILITY NUMBER:
343604550
ADMINISTRATOR:HETZEL, DANIELLEFACILITY TYPE:
850
ADDRESS:5451 LEMON HILL AVE.TELEPHONE:
(916) 433-2655
CITY:SACRAMENTOSTATE: CAZIP CODE:
95824
CAPACITY: 50TOTAL ENROLLED CHILDREN: 50CENSUS: 16DATE:
01/12/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Theresa PerezTIME COMPLETED:
12:15 PM
NARRATIVE
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On January 12, 2024, Licensing Program Analysts (LPAs) Amanda Sutter and Soleil Marx met with Site Supervisor Theresa Perez for the purpose of an unannounced Case Management inspection. LPA observed 16 children supervised by 3 staff.

Through interviews, LPAs learned that the facility provides sheets and blankets to napping children. Staff 1 (S1) stated that yesterday, January 11, 2024, there were 14 children present at the facility. S1 stated that two children had no sheets and four children had no blankets. S1 stated that staff had contacted the district about acquiring more blankets and were told that they were given 2 full sets. S1 stated that the facility does not even have 1 full set. LPAs spoke with Staff 2 (S2) who confirmed this information.

Based on the inspection, one Title 22 Deficiency has been issued on the attached LIC 809-D. Exit interview conducted and report was reviewed with Site Supervisor Theresa Perez. A notice of site visit was given and must remain posted for 30 days. Site Supervisor has been provided with appeal rights.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Amanda Sutter
LICENSING EVALUATOR SIGNATURE: DATE: 01/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/12/2024
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 2
Document Has Been Signed on 01/12/2024 12:08 PM - It Cannot Be Edited


Created By: Amanda Sutter On 01/12/2024 at 11:33 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: SKILLS CHILDREN'S CENTER
FACILITY NUMBER: 343604550

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/06/2024
Section Cited
CCR
101239.1(c)

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101239.1 Napping Equipment (c) Each cot or mat shall be equipped with a sheet to cover the cot or mat and, depending on the weather, a sheet and/or blanket to cover the child.

This requirement is not met as evidenced by:
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LPA wil return to the facility to observe that there is the sufficient amount of sheets and blankets for the number of children enrolled in the facility.
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Based on interview, the facility does not have enough blankets and sheets for children enrolled, which poses a potential health, safety or personal rights risk to persons in care.
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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:Seychelle De Luca
LICENSING EVALUATOR NAME:Amanda Sutter
LICENSING EVALUATOR SIGNATURE:
DATE: 01/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/12/2024


LIC809 (FAS) - (06/04)
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