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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500846
Report Date: 04/29/2024
Date Signed: 01/17/2025 12:36:49 PM

Document Has Been Signed on 01/17/2025 12:36 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:KIDS PLACE 2 EXPLORE & LEARN LLCFACILITY NUMBER:
394500846
ADMINISTRATOR/
DIRECTOR:		ALVARADO, JOCELYNFACILITY TYPE:
850
ADDRESS:1525 WILBANKS LANETELEPHONE:
(209) 221-0469
CITY:TRACYSTATE: CAZIP CODE:
95376
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 14DATE:
04/29/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Maria Carina Barajas TIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
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** This is an amended report **

On April 29, 2024, Licensing Program Analyst (LPA) Stacey Williams met with Facility Representative, Maria Carina Barajas for a case management inspection. LPA observed (14) fourteen preschool students supervised by three staff.

On April 24, 2024, Community Care Licensing received an unusual incident report detailing a child (C1) sustained an injury while in care. The report states the Facility Representative grabbed the child’s arm while instructing them to go inside of the facility. Facility Representative was interviewed. Per the Facility Representative, the child unknowingly pulled their body weight down, which resulted in the injury. C1’s parent was immediately notified of the injury. C1 was provided medical care and returned to the facility the following day.


Exit interview conducted at which time the report was reviewed with Facility Representative, Maria Carina Barajas. A Notice of Site Visit was 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 $100.00.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Stacey Williams
LICENSING EVALUATOR SIGNATURE: DATE: 01/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2025
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 04/29/2024 02:49 PM - It Cannot Be Edited


Created By: Stacey Williams On 04/29/2024 at 02:03 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: KIDS PLACE 2 EXPLORE & LEARN LLC
FACILITY NUMBER: 394500846

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
04/30/2024
Section Cited
CCR
101223(a)(3)

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(a) The licensee shall ensure that each child is accorded the following personal rights:(3) 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 withholding of shelter, clothing, medication or aids to physical functioning.
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Facility Representative will review with all staff Title 22 regulations pertaining to personal rights. Staff will also review personal rights video module on the CDSS website.
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This requirement was not met as evidenced by: Staff reported they grabbed C1's arm. C1 unknowingly pulled their body weight down which resulted in C1 being injured. This poses an immediate risk the health and safety of children in care.
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Facility Representative will provide CCL a written statement indicating that all staff have reviewed the regulations and the video.
Statement with signatures will be provided to CCL by POC date- 4/30/24.

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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: 04/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/29/2024


LIC809 (FAS) - (06/04)
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