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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343622428
Report Date: 06/26/2023
Date Signed: 06/26/2023 01:08:48 PM

Document Has Been Signed on 06/26/2023 01:08 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:VILLAGE PRESCHOOL CENTERFACILITY NUMBER:
343622428
ADMINISTRATOR:TOMIKA RAINEARFACILITY TYPE:
850
ADDRESS:6845 LARCHMONT DRIVETELEPHONE:
(916) 566-3485
CITY:NORTH HIGHLANDSSTATE: CAZIP CODE:
95660
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 0DATE:
06/26/2023
TYPE OF VISIT:Case Management - IncidentANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Mikako Fisher-HillTIME COMPLETED:
01:30 PM
NARRATIVE
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On June 26, 2023 at 12:30 PM, Licensing Program Analyst (LPA) Tanya Washington met with Program Administrator Mikako Fisher-Hill for a scheduled case management visit regarding a self- reported unusual incident which occurred on 05/10/2023. LPA met the administrator at 155 Morey Ave, Sacramento, CA 95838. This facility follows Twin Rivers School District schedule and is closed for summer break until 08/16/2023.

It was reported that on May 10, 2023 approximately at 11:50 AM, Child #1 was noticed to be unaccounted for inside the classroom. Staff addressed the issue by checking all areas of the classroom and outdoor play area. Prior to Child #1s unknown whereabouts the class was outdoors on the enclosed playground. During transition from outside to inside the playground staff miscounted the number of children causing Child #1 to be left outside for approximately 15 minutes. Staff located Child #1 on the enclosed playground unharmed and returned them back to class.

Since the incident, facility has taken the following steps to correct the zero tolerance violation of absence of supervision:
- Staff addressed the issue and went over policy and procedures
- Notified and reported the incident to Child #1’s parent
- Notified and reported to program director
- Provided necessary refresh training for staff regarding supervision and transitions

Upon receipt, facility representative shall post and provide copies of this licensing report to parents/ guardians of children who are currently enrolled as well as parents/ guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must acknowledge receipt of this report and citation by signing a LIC9224, “ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS”. A copy of this form should be placed in each child file upon receipt from parent.

Refer to LIC809D for citation information.

LPA discussed this report with Mikako Fisher-Hill and conducted an exit interview. LPA also provided and explained appeal rights. Notice of site visit was not provided as the facility is closed until 08/16/2023.

SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE: DATE: 06/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/26/2023
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 06/26/2023 01:08 PM - It Cannot Be Edited


Created By: Tanya Washington On 06/20/2023 at 03:30 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: VILLAGE PRESCHOOL CENTER
FACILITY NUMBER: 343622428

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/26/2023
Section Cited
CCR
101229(a)(1)

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The licensee shall provide care and supervision as necessary to meet the children's needs. 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 is not met as evidenced by:
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Staff received training regarding supervision and transitions of children. Facility has reported the incident to the child's parent and reported this incident to CCL. This deficiency is cleared.
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Facility self reported that on May 10, 2023, during transition from outside to inside Child #1 was left unattended on the playground for approximately 15 minutes. This is an immediate health and safety risk to 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:Tanya Washington
LICENSING EVALUATOR SIGNATURE:
DATE: 06/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/20/2023


LIC809 (FAS) - (06/04)
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