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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343617215
Report Date: 06/10/2024
Date Signed: 06/10/2024 01:16:32 PM

Document Has Been Signed on 06/10/2024 01:16 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:KELLI'S PALS PRESCHOOL & DAY CAREFACILITY NUMBER:
343617215
ADMINISTRATOR/
DIRECTOR:		BOYD, LINFACILITY TYPE:
850
ADDRESS:501 SAN JUAN ROADTELEPHONE:
(916) 922-0724
CITY:SACRAMENTOSTATE: CAZIP CODE:
95834
CAPACITY: 56TOTAL ENROLLED CHILDREN: 56CENSUS: 21DATE:
06/10/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:55 AM
MET WITH:Lin BoydTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
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On Monday June 10th, 2024, Licensing Program Analyst (LPA) Mandie Goodwin and Licensing Program Manager (LPM) Seychelle De Luca met with Director Lin Boyd for the purpose of an unannounced 1 year required inspection. Director guided LPA on a tour of the facility, at which time a census of 13 preschool children with 2 staff were observed in one building, while 8 school age children supervised by one teacher were observed in another building. All individuals subject to criminal background review have obtained clearance.

A health and safety inspection was conducted in the classrooms, restrooms, food service area, and outdoor play areas. LPA observed all postings. 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. There are bins for solid waste. The floors appeared clean throughout the facility. LPA observed smoke detectors, and a serviced fire extinguisher. LPA did not observe a carbon monoxide detector, director stated that she will purchase one. Nap equipment was stored appropriately with bedding separated. LPA observed a current roster and documentation that facility is conducting emergency disaster drills at least every 6 months. Per record the last fire drill was conducted May 9th, 2024. Facility conducts sign in and outs digitally.

Children have access to water indoors and outdoors using cups and a brita filter system that is filled from one sink in the kitchen area. Playground equipment and surfaces are free of loose or sharp parts. LPA observed sufficient cushioning of bark. Outdoor shade is provided by trees, and sides of buildings. There are no firearms or bodies of water on the premises. Director stated there are no poisons on the premises.

LPA reviewed present staff files. One staff present was missing all immunization, a health screening, and mandated reporter training from their file, and one staff present was missing the MMR immunization from file.(Report continues 809-C)

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Mandie Goodwin
LICENSING EVALUATOR SIGNATURE: DATE: 06/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/10/2024
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 06/10/2024 01:16 PM - It Cannot Be Edited


Created By: Mandie Goodwin On 06/10/2024 at 12:29 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: KELLI'S PALS PRESCHOOL & DAY CARE
FACILITY NUMBER: 343617215

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/10/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.954
Licensure Requirements
Every licensed child day care center shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and observation, the licensee did not comply with the section cited above in 2 out of 2 counts which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/17/2024
Plan of Correction
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Licensee will install 1 operational carbon monoxide detectors in each building. Licensee will send video of installed and operating detectors.
Type B
Section Cited
WD
101700(b)
Written Directives for Lead Testing
(b) All licensed Child Care Centers operating in buildings constructed before January 1, 2010, shall test their water for lead pursuant to these written directives.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and interview, the licensee did not comply with the section cited above in by not completing lead testing which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/24/2024
Plan of Correction
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Licensee stated they are completing forms and will need to schedule lead testing. Licensee will send completed LIC9275, LIC9276, and floor plan to LPA Goodwin and complete lead testing.
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: 06/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/10/2024


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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: KELLI'S PALS PRESCHOOL & DAY CARE
FACILITY NUMBER: 343617215
VISIT DATE: 06/10/2024
NARRATIVE
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A sample of 5 children's records were reviewed and observed to be complete.

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.

Director 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.

LPA referred licensee to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

LPA discussed the safe sleep regulations with Director 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 Director 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/. Continued on 809-C

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Mandie Goodwin
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2024
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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: KELLI'S PALS PRESCHOOL & DAY CARE
FACILITY NUMBER: 343617215
VISIT DATE: 06/10/2024
NARRATIVE
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Director 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.

Exit interview conducted and report was reviewed with the Director Lin Boyd. Based on the areas evaluated, title 22 deficiencies were cited today. A notice of site visit was given and must remain posted for 30 days. 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: 06/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/10/2024 01:16 PM - It Cannot Be Edited


Created By: Mandie Goodwin On 06/10/2024 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: KELLI'S PALS PRESCHOOL & DAY CARE
FACILITY NUMBER: 343617215

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/10/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101217(a)
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator, and each employee...

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 two files, which was not completed with immunizations, and one file which was not completed with a Health Screening which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/24/2024
Plan of Correction
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Licensee will complete staff files and send copies of missing documents to LPA Goodwin.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Mandie Goodwin
LICENSING EVALUATOR SIGNATURE:
DATE: 06/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/10/2024


LIC809 (FAS) - (06/04)
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