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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393616059
Report Date: 03/28/2024
Date Signed: 03/28/2024 12:21:20 PM


Document Has Been Signed on 03/28/2024 12:21 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:ZION CHILD CARE CENTERFACILITY NUMBER:
393616059
ADMINISTRATOR:JENNIFER SAWYERFACILITY TYPE:
850
ADDRESS:105 SOUTH HAM LANETELEPHONE:
(209) 369-1910
CITY:LODISTATE: CAZIP CODE:
95242
CAPACITY:84CENSUS: 51DATE:
03/28/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Jennifer SawyerTIME COMPLETED:
12:30 PM
NARRATIVE
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On 03/28/2024, Licensing Program Analyst Katy Velazquez (LPA) conducted a field visit to the facility for the purpose of a case management inspection. LPA arrived at the facility and met with Director Jennifer Sawyer (D1). LPA disclosed the purpose of the inspection and was granted entrance into the facility. LPA toured the facility and observed 51 preschool aged children being supervised by 7 staff members. LPA determined, through accessing Guardian, that all required adults were background cleared and associated to the license.

D1 did not report the unusual incident which occurred in February, 2024 which could threaten the physical or emotional health or safety of a child in care. The lack of reporting poses/posed a risk to the health, safety, and personal rights of person(s) in care. As a result, a Type-B deficiency was cited on a subsequent 809-D page.

An exit interview was conducted, and the report was reviewed with Director Sawyer. LPA provided D1 with Licensee Appeal Rights. A Notice of Site visit was posted by LPA and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR NAME: Katy VelazquezTELEPHONE: 916-926-9100
LICENSING EVALUATOR SIGNATURE:
DATE: 03/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/28/2024
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 03/28/2024 12:21 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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827


FACILITY NAME: ZION CHILD CARE CENTER
FACILITY NUMBER: 393616059

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/04/2024
Section Cited
CCR
101212(d)(1)

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Reporting Requirements...a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven
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D1 will watch “Child Care Reporting Requirements” on the CCLD website and report to LPA via email that she has done so by 5 PM on 04/04/2024. An LIC 624 Unusual Incident Report will be submitted via email to LPA by 5 PM on 04/04/2024.
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days following the occurrence of such event...

This requirement was not met as evidenced by an unusual incident in February 2024 not being reported to the Department and an LIC 624 not being submitted within 7 days.
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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: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR NAME: Katy VelazquezTELEPHONE: 916-926-9100
LICENSING EVALUATOR SIGNATURE:
DATE: 03/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/28/2024
LIC809 (FAS) - (06/04)
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