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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390313312
Report Date: 06/06/2024
Date Signed: 06/06/2024 01:02:55 PM

Document Has Been Signed on 06/06/2024 01:02 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 SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:WEST VALLEY CHRISTIAN ACADEMY CHILD CARE-COUGAR CLFACILITY NUMBER:
390313312
ADMINISTRATOR/
DIRECTOR:
MICHELE SMITHFACILITY TYPE:
840
ADDRESS:1790 SEQUOIA BOULEVARDTELEPHONE:
(209) 835-2783
CITY:TRACYSTATE: CAZIP CODE:
95376
CAPACITY: 112TOTAL ENROLLED CHILDREN: 112CENSUS: 50DATE:
06/06/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:22 AM
MET WITH:Sarina Buchanon TIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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On June 6, 2024, Licensing Program Analyst (LPA) Stacey Williams met with Facility Representative, Sarina Buchanan for the purpose of an unannounced annual /random inspection. The facility operates Monday- Friday, 7:00AM- 8:30 AM, and 2:50PM- 5:30PM during the school year. Summer program hours are 8:00AM- 5:00PM. Upon arrival, there were fifty (50) children present for the summer program that were supervised by seven staff. Criminal record clearances were verified. There is shared space waiver on file.

LPA conducted a health and safety inspection for all areas accessible to children. There are no poisons on the premises. Toxic and hazardous items are inaccessible to children. Furniture and equipment are in good condition. LPA observed a functional smoke/carbon monoxide detector and a fully charged 2A :10BC fire extinguisher. The floors appeared clean throughout the facility. Outdoor play area is free from dangerous conditions and playground equipment is securely anchored to the ground. Facility uses bark under the play equipment to absorb falls. Program provides morning and afternoon snack. Menus were posted in the entry of the facility. The facility utilizes drinking water from water bottles. Sign in/out is done electronically through the ProCare App.

Selected child files were reviewed. Staff files were also reviewed. Files contained the required documentation by regulation. LPA discussed mandated reporter training with the Director. Mandated Reporter Training is current in staff files that were reviewed. Mandated Reporter Training is to be completed every two years and can be accessed at www.mandatedreporterca.com. CPR/First Aid certification was reviewed. Expiration date is 7/2025 for the Director.

LPA reviewed the Department's inspection authority and discussed with staff any changes that may occur regarding Director/Site Supervisor or an employee acting in the director's absence must be reported to department within 10 working days.

Report continues on LIC 809-C

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Stacey Williams
LICENSING EVALUATOR SIGNATURE: DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/06/2024
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
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: WEST VALLEY CHRISTIAN ACADEMY CHILD CARE-COUGAR CL
FACILITY NUMBER: 390313312
VISIT DATE: 06/06/2024
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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.

The Facility has COMPLETED WATER TESTING AND REMEDIATION: Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For childcare center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP). LPA verified that the lead testing was completed in accordance with the Written Directives outlined in PIN 21-21.1-CCP.

This facility provides Incidental Medical Services. Facility has an Incidental Medial Service Plan on file. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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

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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication. Director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

No Title 22 deficiencies were observed during this inspection.

LPA reviewed report with the Facility Representative, Sarina Buchanan and provided copies of the report along with Appeal Rights. A notice of site visit was provided and posted by LPA Williams and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Stacey Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2024
LIC809 (FAS) - (06/04)
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