343614520-9-5-2023-03-CC-MGON-CVDRZW-20230905132838

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343614520
Report Date: 09/05/2023
Date Signed: 09/05/2023 01:29:30 PM

Document Has Been Signed on 09/05/2023 01:29 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:	ISABELLE JACKSON ELEMENTARY SCHOOL		FACILITY NUMBER:	343614520
ADMINISTRATOR:	ANDERSON, JANET		FACILITY TYPE:	850
ADDRESS:	8351 CUTLER WAY		TELEPHONE:	(916) 689-2115
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95828
CAPACITY: 40	TOTAL ENROLLED CHILDREN: 40	CENSUS: 13	DATE:	09/05/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Scott Hadley		TIME COMPLETED:	01:45 PM

NARRATIVE

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On Tuesday September 5th 2023, Licensing Program Analyst (LPA) Mandie Goodwin met with Principal Scott Hadley for the purpose of an unannounced 1 year required inspection. Facility operates a Head Start Program in classroom K-1 from 8:00am-2:30pm. LPA toured the classroom, at which time a census of 13 preschool children supervised by 4 staff members were observed.

A health and safety inspection were conducted in the classrooms, restrooms, and outdoor play areas. LPA 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. There were no medications stored at the facility at time of visit. 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. LPA observed a serviced fire extinguisher. Nap equipment was stored appropriately with bedding separated.

Children have access to water indoors and outdoors. Playground equipment and surfaces are free of loose or sharp parts. LPA observed sufficient cushioning of bark. Outdoor shade is provided by canopies, trees, and sides of buildings. There are no firearms or bodies of water on the premises. Poisons are appropriately locked.

LPA reviewed present staff files. At least one staff member present today has current Pediatric CPR and First Aid certification. LPA observed immunization records and documentation of the educational background, training, and/or experience. Upon review, all staff members had current mandated reporter trainings. LPA advised AB 1207 Mandated Reporter training must be renewed every two years and can be renewed at mandatedreporterca.com. (Report continues 809-C)

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Mandie Goodwin
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2023

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 09/05/2023 01:29 PM - It Cannot Be Edited

Created By: Mandie Goodwin On 09/05/2023 at 12:50 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: ISABELLE JACKSON ELEMENTARY SCHOOL	FACILITY NUMBER: 343614520
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/05/2023

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 record review, the licensee did not comply with the section cited above by not having a current director's name and information on file with Community Care Licensing which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/26/2023
	Plan of Correction
1 2 3 4	Licensee will send a director packet for designated on-site supervisor with all required forms by the above POC 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:

Mandie Goodwin

LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2023

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: ISABELLE JACKSON ELEMENTARY SCHOOL	FACILITY NUMBER: 343614520
	VISIT DATE: 09/05/2023

NARRATIVE

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Facility has record of conducting fire drills at least every 6 months with the last fire drill being conducted in August. LPA observed a roster and that children were signed in and out of facility.

A sample of 3 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.

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.

Principal 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).

LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

Continued on 809-C

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Mandie Goodwin
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2023

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: ISABELLE JACKSON ELEMENTARY SCHOOL	FACILITY NUMBER: 343614520
	VISIT DATE: 09/05/2023

NARRATIVE

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LPA discussed the safe sleep regulations with Principal and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Principal of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

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/.

Principal 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 the Principal Scott Hadley. Based on the areas evaluated, a type B title 22 deficiencies was cited today. 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: 09/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2023

LIC809 (FAS) - (06/04)

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