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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343621912
Report Date: 06/21/2023
Date Signed: 06/21/2023 01:22:40 PM

Document Has Been Signed on 06/21/2023 01:22 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:MOORE LEARNING PRESCHOOL & CHILDCARE CENTERFACILITY NUMBER:
343621912
ADMINISTRATOR:BRIDGET BROWNFACILITY TYPE:
850
ADDRESS:8699 ELK GROVE BOULEVARDTELEPHONE:
(916) 405-0448
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 71TOTAL ENROLLED CHILDREN: 71CENSUS: 32DATE:
06/21/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Jennie TeldosTIME COMPLETED:
01:45 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Christopher Bello and Jennie Teldos met with Director, Bridget Brown, regarding an Unusual Incident that took place June 13th 2023. LPA made observations and interviewed the director regarding the incident.

The facility self-reported the incident to the Sacramento Regional Office.

Director stated that she has had a staff training to prevent any similar incidents from occurring again.

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. This report was reviewed and discussed with licensee. A notice of site visit and appeal rights were provided.
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Christopher Bello
LICENSING EVALUATOR SIGNATURE: DATE: 06/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/21/2023
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 06/21/2023 01:22 PM - It Cannot Be Edited


Created By: Christopher Bello On 06/21/2023 at 01:10 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: MOORE LEARNING PRESCHOOL & CHILDCARE CENTER
FACILITY NUMBER: 343621912

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/21/2023
Section Cited
CCR
101229(a)(1)

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No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement has not been met by evidence: Facility self-reported the incident to the RO. This is considered
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Director has conducted trainings with staff to prevent any similar incident from occuring in the future. LPA cleared the deficiency.
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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: 06/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2023


LIC809 (FAS) - (06/04)
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