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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624433
Report Date: 03/17/2023
Date Signed: 03/17/2023 11:04:54 AM

Document Has Been Signed on 03/17/2023 11:04 AM - 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:GENIUS KIDS-ELK GROVE FLORIN ROAD CAMPUS(PS)FACILITY NUMBER:
343624433
ADMINISTRATOR:DHILLON, RENNUFACILITY TYPE:
850
ADDRESS:8065 ELK GROVE FLORIN RD. #160TELEPHONE:
(510) 364-4033
CITY:SACRAMENTOSTATE: CAZIP CODE:
95829
CAPACITY: 78TOTAL ENROLLED CHILDREN: 78CENSUS: 4DATE:
03/17/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Shana NijjarTIME COMPLETED:
11:30 AM
NARRATIVE
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Licensing Program Analyst (LPA) Christopher Bello arrived at the facility at approximately 8:30am and met with Director Shana Nijjar regarding an Unusual Incident that took place March 7, 2023. LPA made observations and interviewed staff regarding the incident. The facility self-reported the incident to the Regional Office.

Director stated they have immediately terminated after they witnessed the incident. They have conducted trainings for staff so that incidents like this do not occur in the future. The parents of the child were also informed of the incident.

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

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee.

SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Christopher Bello
LICENSING EVALUATOR SIGNATURE: DATE: 03/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/17/2023
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 03/17/2023 11:04 AM - It Cannot Be Edited


Created By: Christopher Bello On 03/17/2023 at 10:53 AM
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: GENIUS KIDS-ELK GROVE FLORIN ROAD CAMPUS(PS)
FACILITY NUMBER: 343624433

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
03/17/2023
Section Cited
HSC
101223(a)(3)

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To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating, sleeping or toileting; or
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Director stated that they immiediately terminated the staff and conducted training for the staff. LPA cleared the deficiency.
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withholding of shelter, clothing, medication or aids to physical functioning. This requirement has not been met by evidence: Facility self reported an incident. This is 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:Roxana Saravia
LICENSING EVALUATOR NAME:Christopher Bello
LICENSING EVALUATOR SIGNATURE:
DATE: 03/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/17/2023


LIC809 (FAS) - (06/04)
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