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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343617466
Report Date: 04/22/2022
Date Signed: 04/22/2022 02:58:21 PM


Document Has Been Signed on 04/22/2022 02:58 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:PENLEIGH CHILD DEVELOPMENT CENTERFACILITY NUMBER:
343617466
ADMINISTRATOR:CAMASURA, MARIVELFACILITY TYPE:
830
ADDRESS:1400 E STREET SUITE D & ETELEPHONE:
(916) 822-5020
CITY:SACRAMENTOSTATE: CAZIP CODE:
95814
CAPACITY:24CENSUS: 14DATE:
04/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Marivel CamasuraTIME COMPLETED:
03:30 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Alize Tillery and Amanda Sutter met with Director Marivel Camasura for the purpose of an unannounced annual random inspection. Director was reminded never to exceed the conditions, limitations and capacity specified on the license. Upon arrival, LPA observed 14 infants, supervised by 5 staff. Facility hours of operation are Monday through Friday from 7:00 AM to 5:30 PM.

LPA toured all activity and classroom spaces (Lady Bug Room and Bumblebees Room), the kitchen area, the napping areas and the outdoor play area. LPAs observed documentation for sleeping infants, every 15 minutes. In the napping area, LPAs observed cribs to be used as storage. LPAs also observed sleep sacks in 4 of the cribs and blankets hanging on the side. Director was reminded that cribs are to be free from any loose objects. LPAs reminded Director that an exemption request needs to be made, in order for sleep sacks to be used. LPA observed the following documents are posted: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, menus, and daily schedule. Cleaning disinfectants, hazardous items, and medications are appropriately stored and inaccessible to children. Director stated there are no poisons on the premises. Furniture and equipment are in good condition, and toileting facilities are in safe, sanitary and operating condition. LPA observed two changing tables in arms reach of a sink. LPA observed infant food and bottles labeled in the refrigerator. LPAs reminded Director to check for dates on the children’s personal bottles. The floors appeared clean throughout the facility. The food preparation space is free of litter, all food was protected against contamination, and storage containers with solid waste have covers.



Drinking water is readily available to children both indoors and outdoors. LPA observed a water pitcher and personal cups indoors, and a water fountain and personal cups outdoors. LPA observed full legal signatures while reviewing the sign in and sign out sheet. There is rubber cushion and artificial grass beneath the playground equipment in the outdoor play area. There are sufficient equipment and toys. There are shaded areas supplied by overhangs and the building.

Report continues on 809-C.

SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Alize TilleryTELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:
DATE: 04/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/22/2022
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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Document Has Been Signed on 04/22/2022 02:58 PM - It Cannot Be Edited

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: PENLEIGH CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 343617466

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/22/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101439.1(f)
Infant Care Center Sleeping Equipment
(f) Cribs shall be free from all loose articles and objects, including blankets and pillows.

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 in that LPAs observed blankets, sleep sacks and play equipment stored and/or hanging on the cribs, which poses/posed a potential health, safety or personal rights risk to persons in care. Infants were not observed in the cribs at this time.
POC Due Date: 04/26/2022
Plan of Correction
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Staff will sign off on a form, confirming that they received a training from the Director, regarding Infant and Safe Sleep Regulations. Director will provide this form to LPA Tillery.
Director will take picture of cribs and send to LPA Tillery.
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 LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Alize TilleryTELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:
DATE: 04/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/22/2022
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: PENLEIGH CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 343617466
VISIT DATE: 04/22/2022
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8 staff files and 5 present day care children file records were reviewed. All children and staff files were observed to be complete. At least one staff member present today has current Pediatric CPR and First Aid certification. All staff currently employed with the facility have a criminal record clearance and health screening reports. Director was reminded that the mandated reporter trainings are to be renewed every two years. There are no firearms or bodies of water on the premises. LPA observed a smoke and carbon monoxide detector. LPA reviewed the Department's inspection authority and discussed with designee any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within ten working days. LPA verified the annual fees are current.

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.


This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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



Licensees 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.

Report continues...
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Alize TilleryTELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: PENLEIGH CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 343617466
VISIT DATE: 04/22/2022
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LPA 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. LPA also informed licensee [facility representative] 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.

A deficiency is cited on the following 809D page. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and the report and appeal rights were reviewed with the Director, Marivel Camasura.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Alize TilleryTELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4