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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343620256
Report Date: 11/19/2024
Date Signed: 11/19/2024 02:03:27 PM

Document Has Been Signed on 11/19/2024 02:03 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:BROOKFIELD PRESCHOOLFACILITY NUMBER:
343620256
ADMINISTRATOR/
DIRECTOR:		DAY, TATANISHAFACILITY TYPE:
850
ADDRESS:6115 RIVERSIDE BLVD.TELEPHONE:
(916) 442-1255
CITY:SACRAMENTOSTATE: CAZIP CODE:
95831
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 45DATE:
11/19/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Tatanisha DayTIME VISIT/
INSPECTION COMPLETED:
02:20 PM
NARRATIVE
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Licensing Program Analyst (LPA) Christopher Bello arrived at the facility at approximately 1:15pm for an unannounced inspection. LPA met with Director Tatanisha Day. During the inspection LPA observed two medications that were expired for two different children. This is considered as an immediate risk the children in care.

Director stated that they have notified the parents to pick the medication up on, but nothing was followed up on.

Title 22 Deficiencies have been cited on the attached LIC 809D. Upon receipt of Type A citations, facility shall post and provide copies of the LIC 809D for parents/guardians of children currently in care and for parents/guardians of newly enrolled children for the next 12 months. Facility must also keep the signed LIC 9224, Acknowledging Receipt of Licensing Reports LIC 809D in each child's files. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director [or facility representative] Tatanisha Day.
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Christopher Bello
LICENSING EVALUATOR SIGNATURE: DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2024
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 11/19/2024 02:03 PM - It Cannot Be Edited


Created By: Christopher Bello On 11/19/2024 at 01:50 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: BROOKFIELD PRESCHOOL
FACILITY NUMBER: 343620256

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/19/2024
Section Cited
CCR
101226(e)(3)(A)

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101226 HEALTH RELATED SERVICES (e) In centers where the licensee chooses to handle medications: .....(3) Prescription medications may be administered if all of the following conditions are met: (A) Prescription medications shall be administered in accordance with the label directions as prescribed by the child's physician.
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Director stated that they will give the expired medications to the parents upon pick-up. LPA will return to clear the deficiency.
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This requirement is not met as evidenced by:
LPA observed two epinephrine injectors that expired on August 2024 and July 2024. This is considered as an immediate risk to the children 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:Amanda Blesi
LICENSING EVALUATOR NAME:Christopher Bello
LICENSING EVALUATOR SIGNATURE:
DATE: 11/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/19/2024


LIC809 (FAS) - (06/04)
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