343623893-5-31-2022-03-CC-KGUA-CEXRGP-20220531130104

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343623893
Report Date: 05/31/2022
Date Signed: 05/31/2022 01:01:14 PM

Document Has Been Signed on 05/31/2022 01:01 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:	BUILDING KIDZ OF CITRUS HEIGHTS		FACILITY NUMBER:	343623893
ADMINISTRATOR:	LYSANDREA JACKSON		FACILITY TYPE:	850
ADDRESS:	8073 GREENBACK LN		TELEPHONE:	(916) 735-3165
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95610
CAPACITY:	40	CENSUS: 19	DATE:	05/31/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Iliyah Demafeliz		TIME COMPLETED:	01:10 PM

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At 10:15 a.m. on Tuesday, May 31st, 2022, Licensing Program Analyst (LPA) Karyn Guerra met with Director, Iliyah Demafeliz, for the purpose of a required - 1 year inspection. LPA observed a census of 19 children supervised by 2 staff. A COVID-19 risk assessment was conducted prior to entering the facility. Operating hours of the facility are from 7:00 a.m.-6:00 p.m., Monday thru Friday.

All individuals subject to criminal background review have obtained criminal record clearance. LPA discussed associating substitute staff to facility. Director 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.

A health and safety inspection was conducted in the classrooms, restrooms, food service areas, and outdoor play areas. LPA observed the following documents are posted: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, menus, and daily schedule. Cleaning disinfectants and hazardous items are appropriately stored and inaccessible to children. No children in care require medications. Director stated there are no poisons on the premises. Furniture and equipment are in good condition, and toileting facilities are in safe, sanitary, and operating condition. Bins for solid waste in the have tight fitting lids. The floors appeared clean throughout the facility. The facility provides breakfast, lunch, and afternoon snack. The food preparation space is free of litter and all food was protected against contamination. Drinking water was readily available to children both indoors and outdoors via drinking fountains and labeled bottles. There are no firearms or bodies of water on the premises. LPA observed a functional carbon monoxide detector. Playground equipment and surfaces are free of loose or sharp parts. LPA observed

Report continues on 809-C.

SUPERVISOR'S NAME: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Karyn Guerra	TELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2022

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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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: BUILDING KIDZ OF CITRUS HEIGHTS	FACILITY NUMBER: 343623893
	VISIT DATE: 05/31/2022

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artificial turf beneath the low plastic play structures. Outdoor shade is provided by shade sails. LPA observed sign in and sign out forms with parent's initials only.

Staff files were reviewed. At least one staff member present today has current Pediatric CPR and First Aid certification. LPA observed immunization records and documentation of the educational background, training, and/or experience and AB 1207 Mandated Reporter training certificates. LPA discussed Director qualifications.

Children's records were reviewed. Each child's file contained an emergency card, consent for emergency medical treatment and notifications of children’s and parent’s rights, health history, physician's report and immunization records.

This facility provides does not provide Incidental Medical Services – IMS. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.

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 discussed annual fees. A staff interview was conducted with the Director, Iliyah Demafeliz.

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.

A Title 22 deficiency cited on the subsequent pages of this report. An exit interview was conducted and report was reviewed with Director, Iliyah Demafeliz. Appeal rights were provided. Director's signature on this report acknowledges receipt of these rights. A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Karyn Guerra	TELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/31/2022 01:01 PM - It Cannot Be Edited

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: BUILDING KIDZ OF CITRUS HEIGHTS	FACILITY NUMBER: 343623893
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/31/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101229.1(a)(1)

Sign In and Sign Out

(a) In addition to the sign-in procedure requirement of Section 101226.1(b), the licensee shall develop, maintain and implement a written procedure to sign the child in/out of the child care center that shall, at a minimum, include the following: (1) The person who signs the child in/out shall use his/her full legal signature and shall record the time of day. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, and record review, the licensee did not comply with the section cited above as LPA observed sign in and sign out logs with parent initials, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/30/2022
	Plan of Correction
1 2 3 4	Director will submit evidence of updated sign in and sign out logs with required signatures to LPA by POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Karyn Guerra	TELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2022

LIC809 (FAS) - (06/04)

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