<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343621414
Report Date: 05/11/2023
Date Signed: 05/11/2023 02:13:20 PM

Document Has Been Signed on 05/11/2023 02:13 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 SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:TOTS OF LOVE - ELK GROVE WESTFACILITY NUMBER:
343621414
ADMINISTRATOR:WILLIAMS, COURTNEYFACILITY TYPE:
850
ADDRESS:3151 DWIGHT ROAD, SUITE 400TELEPHONE:
(916) 689-8687
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY: 37TOTAL ENROLLED CHILDREN: 37CENSUS: 12DATE:
05/11/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Mary TermeteetTIME COMPLETED:
02:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 05/11/2023, Licensing Program Analyst Katy Maestas (LPA) conducted an unannounced field visit for the purpose of a Case Management inspection. LPA disclosed the purpose of the inspection and was granted entrance into the facility. LPA met with Teacher Mary Termeteet (T1) as the Site Supervisor was on vacation and the Director was not present.

LPA conducted a tour of the facility and observed 12 children being supervised by 4 adults. LPA accessed Guardian and determined that 3 of the 4 Staff members were background cleared and associated to the license. As a result, a Type-A deficiency was cited on a subsequent 809-D page and the report was reviewed with T1. T1 understands that all parents or authorized representatives of currently enrolled children must sign the LIC 9224 form, and the form must be available to the Department for review. T1 understands that parents or authorized representatives of children enrolling for up to one year must sign the LIC 9224 form, and the form must be available to the Department for review.

LPA learned that the facility had a pipe burst on 03/14/2023 which resulted in a flood. Due to water damage, the facility was temporarily closed from 03/14/2023 until 05/02/2023. The flood nor the temporary closure was reported to the Department. As a result, a deficiency was cited on a subsequent 809-D page and the report was reviewed with T1 during an exit interview. LPA provided T1 with Appeal Rights. A Notice of Site visit was posted by LPA and must remain posted for 30 days. Failure to comply with posting requirements will result in an immediate civil penalty of $100.

SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Nola Maestas
LICENSING EVALUATOR SIGNATURE: DATE: 05/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/11/2023
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 05/11/2023 02:13 PM - It Cannot Be Edited


Created By: Nola Maestas On 05/11/2023 at 01:32 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: TOTS OF LOVE - ELK GROVE WEST
FACILITY NUMBER: 343621414

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/11/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/12/2023
Section Cited
CCR
87355(e)(1)

1
2
3
4
5
6
7
87355 Criminal Record Clearance (e) All
individuals subject to criminal record
review...shall prior to working...in a licensed
facility: (1) obtain a California clearance...as
required by the Department. This requirement
is not met as evidenced by:
1
2
3
4
5
6
7
T1 will send proof of either a Livescan or Transfer Request to LPA via email by closing on 05/12/2023. The staff member may not return to work until she is cleared and associated to the license as evidenced by Guardian. T1 may call Officer of the Day to ask for clearance.
8
9
10
11
12
13
14
Based on LPA observation and record review, the Director did not ensure a criminal clearance was obtained for 1 staff member which poses an immediate health, safety and or personal rights risk to chidlren in care.
8
9
10
11
12
13
14
Type B
05/18/2023
Section Cited
CCR101212

1
2
3
4
5
6
7
101212 Reporting Requirements...a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within 7...
1
2
3
4
5
6
7
The Director will write and sign a statement aknowledging that she understands that unusual incidents must be reported to the Department within 24 hours of the occurance. The Director will email this statement to LPA by closing on 05/18/2023.
8
9
10
11
12
13
14
(1) Events reported shall include the following: (G)Catastrophes.This requirement was not met as evidenced by the Department not being notified of a pipe bursting nor the facilty's closure. This incident posed a potential Health, Safety, or Personal Rights risk.

8
9
10
11
12
13
14
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:Jeanne Smith
LICENSING EVALUATOR NAME:Nola Maestas
LICENSING EVALUATOR SIGNATURE:
DATE: 05/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/11/2023


LIC809 (FAS) - (06/04)
Page: 2 of 2