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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624951
Report Date: 01/19/2024
Date Signed: 01/19/2024 03:23:32 PM

Document Has Been Signed on 01/19/2024 03:23 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:L'ACADEMY LANGUAGE IMMERSION PRESCHOOL FOLSOMFACILITY NUMBER:
343624951
ADMINISTRATOR:ROYAL, ANNAFACILITY TYPE:
830
ADDRESS:1815 PRAIRIE CITY ROADTELEPHONE:
(408) 916-7536
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY: 28TOTAL ENROLLED CHILDREN: 28CENSUS: 2DATE:
01/19/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Anna RoyalTIME COMPLETED:
03:20 PM
NARRATIVE
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Licensing Program Analysts Stephanie Piring (LPA) and LPA Jennifer Velasco conducted a case management inspection and met with Director Anna Royal (Director), who was reminded that all staff must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Child Care Center. LPA record reviews and interviews provided evidence that two staff worked in the facility without having their clearance or documentation transferred to the facility.

Based on today's inspection, one Type B deficiency is being cited on 809-D. Exit interview was conducted and this report was reviewed with Director Anna Royal, has been provided with appeal rights and this report. Notice of Site was provided and must remain posted for 30 days.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Jennifer Velasco
LICENSING EVALUATOR SIGNATURE: DATE: 01/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/19/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 01/19/2024 03:23 PM - It Cannot Be Edited


Created By: Jennifer Velasco On 01/19/2024 at 01:14 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: L'ACADEMY LANGUAGE IMMERSION PRESCHOOL FOLSOM
FACILITY NUMBER: 343624951

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/21/2024
Section Cited
CCR
101170(e)

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(e) All individuals subject to a criminal record review ... shall prior to working, residing or volunteering in a licensed facility … (2) Request a transfer of a criminal record clearance as specified in Section 101170(f) or (3) Request and be approved for a transfer of a criminal
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Director stated she will not allow anyone to work at the facility unless she has verification that the individual is associated to the facility. Director stated for the next three weeks, she will document any substitute staffing and will document her ensuring all staff are associated to the facility. Director stated
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record exemption,
This requirement is not met as evidenced by LPA's record review and witness statements that two staff who were cleared but not associated to the facility provided care to infants. This constitutes a potential health, safety, and/or personal rights risk to children in care.
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she will email that documentation to LPA by end of day POC due date.
jennifer.velasco@dss.ca.gov

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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:Natalie Dunaway
LICENSING EVALUATOR NAME:Jennifer Velasco
LICENSING EVALUATOR SIGNATURE:
DATE: 01/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/19/2024


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