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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393611617
Report Date: 08/06/2024
Date Signed: 08/06/2024 03:01:47 PM

Document Has Been Signed on 08/06/2024 03:01 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
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:EL CONCILIO PRESCHOOL & INFANT CENTERFACILITY NUMBER:
393611617
ADMINISTRATOR/
DIRECTOR:		DANYA ZIZUMBOFACILITY TYPE:
850
ADDRESS:4701 FARMINGTON ROADTELEPHONE:
(209) 462-7846
CITY:STOCKTONSTATE: CAZIP CODE:
95215
CAPACITY: 44TOTAL ENROLLED CHILDREN: 21CENSUS: 20DATE:
08/06/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:50 PM
MET WITH:Kim Motz TIME VISIT/
INSPECTION COMPLETED:
03:10 PM
NARRATIVE
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On August 6, 2024, Licensing Program Analyst (LPA) Stacey Williams arrived at the facility for the purpose of conducting a case management inspection. LPA met with Facility Representative, Kim Motz. LPA observed twenty (20) napping children supervised by five staff ( 2 classrooms).

LPA toured the facility and met with Facility Representative regarding an incident that was reported to Community Care Licensing on July 17, 2024. The incident report included information detailing how child 1 (c1) was left in the classroom napping during a fire drill. Facility staff involved in the incident was interviewed during today's inspection. Statements received revealed that a classroom headcount was initially conducted when the fire alarm went off; however due to a parent signing a child out at the same time; staff assumed the parent took the child with them which altered the headcount. It was reported as a few minutes the child was left unsupervised. Staff also reported they did not leave the facility and was within close proximity to the classroom when it was realized that C1 remained sleeping in the classroom.

Based on the information received, title 22 deficiencies will be cited on subsequent page, LIC 809D.

Exit interview conducted and report was reviewed with the Facility Representative, Kim Motz. A notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Appeal Rights were provided.


SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Stacey Williams
LICENSING EVALUATOR SIGNATURE: DATE: 08/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/06/2024
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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Document Has Been Signed on 08/06/2024 03:01 PM - It Cannot Be Edited


Created By: Stacey Williams On 08/06/2024 at 02:34 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: EL CONCILIO PRESCHOOL & INFANT CENTER
FACILITY NUMBER: 393611617

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/06/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/06/2024
Section Cited
CCR
101229(a)(1)

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(a) The licensee shall provide care and supervision as necessary to meet the children's needs.
(1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
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Per incident report, staff will undergo training on supervision, headcounts and emergency evacuation plan. Training material and roster will be provided to CCL by POC date: 9/6/24.
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This requirement was not met as evidenced by: Staff left a child unsupervised sleeping in the classroom while outside during a fire drill. This poses an potential risk to the health and safety of 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:Bettina Engelman
LICENSING EVALUATOR NAME:Stacey Williams
LICENSING EVALUATOR SIGNATURE:
DATE: 08/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/06/2024


LIC809 (FAS) - (06/04)
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