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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343617215
Report Date: 07/07/2022
Date Signed: 07/07/2022 02:42:57 PM

Document Has Been Signed on 07/07/2022 02:42 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:KELLI'S PALS PRESCHOOL & DAY CAREFACILITY NUMBER:
343617215
ADMINISTRATOR:BOYD, LINFACILITY TYPE:
850
ADDRESS:501 SAN JUAN ROADTELEPHONE:
(916) 922-0724
CITY:SACRAMENTOSTATE: CAZIP CODE:
95834
CAPACITY: 56TOTAL ENROLLED CHILDREN: 56CENSUS: 24DATE:
07/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Lin BoydTIME COMPLETED:
03:00 PM
NARRATIVE
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On Thursday, July 7, 2022 at 12:00 PM, Licensing Program Analysts (LPA) Amanda Sutter and Kelly Ferrara met with Director Lin Boyd for the purpose of an unannounced required annual inspection. LPAs observed 24 children supervised by 6 staff. The facility hours of operation are Monday through Friday from 6:00 AM to 6:00 PM.

LPAs toured two classroom spaces, restrooms, kitchen, and two outdoor play areas. LPAs observed the following documents are posted: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, menu, and seat belt law. Medications are appropriately stored and inaccessible to children. Director stated there are no poisons or firearms on the premises. LPAs observed cleaning disinfectants and hazardous items stored under an unlocked kitchen sink. Furniture and equipment are in good condition, and toileting facilities are in safe, sanitary and operating condition. The program provides breakfast, lunch, two snacks, and occasionally dinner. Food is prepared at the facility.

LPAs observed trash bins with tight fitted lids. Drinking water is readily available to children both indoors and outdoors. LPAs observed water pitchers and personal water bottles being used. LPAs observed the facility’s electronic sign in and out system. Facility has record of conducting fire drills at least every six months; last fire drill was conducted in June 4, 2022. Playground equipment and surfaces are free of loose or sharp parts and bark is present under the equipment to provide sufficient cushioning. There are sufficient equipment and toys, and there are shaded areas supplied by trees and the building. Children take their water bottles outside.

Six staff and ten children's records were reviewed. Child files were observed to be incomplete. All staff files observed were missing a current mandated reporter certificate. There is at least one staff member present with a current CPR certificate. LPAs observed a functional carbon monoxide detector, smoke detector and fire extinguisher. PAGE 1. REPORT CONTINUES ON LIC809-C

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Amanda Sutter
LICENSING EVALUATOR SIGNATURE: DATE: 07/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/07/2022
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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: KELLI'S PALS PRESCHOOL & DAY CARE
FACILITY NUMBER: 343617215
VISIT DATE: 07/07/2022
NARRATIVE
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LPAs discussed the safe sleep regulations with licensee 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. LPAS also informed licensee 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 Service (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/ (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

Director 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.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

A notice of site visit was given and must remain posted for 30 days. Based on the inspection, four type B citation has been issued. Exit interview conducted and report was reviewed with facility representative Lin Boyd.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Amanda Sutter
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 07/07/2022 02:42 PM - It Cannot Be Edited


Created By: Amanda Sutter On 07/07/2022 at 02:14 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
, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: KELLI'S PALS PRESCHOOL & DAY CARE
FACILITY NUMBER: 343617215

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/07/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238(g)
Buildings and Grounds
(g) Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. LPAs observed cleaning supplies and bleach under an unlocked cabinet in a kitchen area, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/04/2022
Plan of Correction
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LPA will return to observe proper storage of cleaning supplies.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in six out of six files reveiwed, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/04/2022
Plan of Correction
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Mandated reporter training can be obtained at mandatedreporterca.com. General training and child care training certificates must be obtained for each staff member by POC date listed above.
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: 07/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/07/2022


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 07/07/2022 02:42 PM - It Cannot Be Edited


Created By: Amanda Sutter On 07/07/2022 at 02:14 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
, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: KELLI'S PALS PRESCHOOL & DAY CARE
FACILITY NUMBER: 343617215

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/07/2022

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
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Based on record review, the licensee did not comply with the section cited above in three out of six staff files reviewed, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/04/2022
Plan of Correction
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LPA will return to review completed staff files.
Type B
Section Cited
CCR
101221(a)
Child's Records
(a) The licensee shall ensure that a separate, complete and current record for each child is maintained in the child care center.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in nine out of ten children files reviewed, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/04/2022
Plan of Correction
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LPA will return to review completed child files.
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: 07/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/07/2022


LIC809 (FAS) - (06/04)
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