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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623772
Report Date: 12/09/2021
Date Signed: 12/09/2021 12:58:31 PM

Document Has Been Signed on 12/09/2021 12:58 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:CREATING CHARACTERS PRESCHOOL ACADEMYFACILITY NUMBER:
343623772
ADMINISTRATOR:JOZALYNNE BYRDFACILITY TYPE:
850
ADDRESS:1515 SPORTS DRIVETELEPHONE:
(916) 710-4037
CITY:SACRAMENTOSTATE: CAZIP CODE:
95834
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: 15DATE:
12/09/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Mirena McNairTIME COMPLETED:
01:20 PM
NARRATIVE
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On Thursday, 12/09/2021, Licensing Program Analyst (LPA) Jan Hoshida conducted an unannounced annual random inspection for the preschool program. LPA met with Administrator Mirena McNair. Upon arrival, LPA observed 15 children supervised by four staff members.

LPA conducted a health and safety inspection inside and outside of the facility. The following areas are in compliance during the inspection. Firearms and ammunition are not on the premises. Administrator acknowledged that storage area for poisons needs to be locked under lock and key. Disinfectants, hazardous items and medications are inaccessible to children. Furniture and equipment are sufficient, age appropriate, and in good repair. Fire drills are conducted and documented. Carbon Monoxide detector was present and in working order. The playground equipment and outdoor activity space is maintained and in good condition. Foam padding is being used as cushioning around the swing equipment and LPA observed that the foam padding was breaking apart. Administrator stated that planning on replacing that soon.

Children's toilets, hand washing facilities are sanitary. Floors are clean and free of debris. Food preparation area is clean, food is protected from contamination and all food or beverages are stored in covered containers and labeled. Drinking water is available both indoors and outside. Menus are posted. The facility is in compliance with conditions and limitations specified on the license. Administrator stated that the facility uses an on-line sign in and sign out system. No excluded individuals are present. Staff subject to a criminal record clearance or exemption are associated to the facility. First Aid/CPR reviewed and in compliance. Emergency information reviewed for some children. Some staff records were reviewed. Facility provides breakfast, lunch, and afternoon snack. Facility’s hours of operation are from Monday through Friday from 6:30 am to 6:00 pm.

REPORT CONTINUED ON NEXT PAGE
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Jan Hoshida
LICENSING EVALUATOR SIGNATURE: DATE: 12/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/09/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: CREATING CHARACTERS PRESCHOOL ACADEMY
FACILITY NUMBER: 343623772
VISIT DATE: 12/09/2021
NARRATIVE
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LPA observed that storage containers for solid waste are not covered. LPA observed that three out of the five staff did not have current Mandated Reporter training on file. Administrator stated that she understands that the Mandated Reporter training must be completed every two years.

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 Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. 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. LPA observed that the facility did not obtain written approval and authorization from the child’s representative for administration of medication.

LPA discussed current COVID guidelines with Administrator. LPA observed that staff were wearing masks.

Facility representative 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.

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.

In the areas that were evaluated, deficiencies were observed at the time of the visit and cited on LIC 809-D. Exit interview conducted and report was reviewed with facility representative Mirena McNair. A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Jan Hoshida
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2021
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Page: 2 of 4
Document Has Been Signed on 12/09/2021 12:58 PM - It Cannot Be Edited


Created By: Jan Hoshida On 12/09/2021 at 12:10 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
, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: CREATING CHARACTERS PRESCHOOL ACADEMY
FACILITY NUMBER: 343623772

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/09/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101239(f)(1)
Fixtures, Furniture, Equipment and Supplies
(f) Solid waste shall be stored, located and disposed of in a manner that will not transmit communicable diseases or odors, create a nuisance, or provide a breeding place or food source for insects or rodents. (1) All containers used for storage of solid wastes, including moveable bins, shall have a tightfitting cover that is kept on; shall be in good repair; and shall be leakproof and rodent-proof.

This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on observation, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/07/2022
Plan of Correction
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Administrator stated that they will purchase a trash can with a tight-fitting lid for the storage of solid waste and will submit proof to LPA by POC due date of 1/7/22.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above for three out of five staff which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/07/2022
Plan of Correction
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Administrator stated that they will submit proof of completed Mandated Reporter training for three staff to LPA by POC due date of 1/7/22.
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 Luca
LICENSING EVALUATOR NAME:Jan Hoshida
LICENSING EVALUATOR SIGNATURE:
DATE: 12/09/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/09/2021


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/09/2021 12:58 PM - It Cannot Be Edited


Created By: Jan Hoshida On 12/09/2021 at 12:10 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
, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: CREATING CHARACTERS PRESCHOOL ACADEMY
FACILITY NUMBER: 343623772

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/09/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101226(e)(3)(B)
Health-Related Services
(3) Prescription medications may be administered if all of the following conditions are met: (B) For each prescription medication, the licensee shall obtain, in writing, approval and instructions from the child's authorized representative for the administration of the medication to the child.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/07/2022
Plan of Correction
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Administrator stated that they will submit completed Parent Consent for Administration of Medications form LIC9221 to LPA by POC due date of 1/7/22.
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 Luca
LICENSING EVALUATOR NAME:Jan Hoshida
LICENSING EVALUATOR SIGNATURE:
DATE: 12/09/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/09/2021


LIC809 (FAS) - (06/04)
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