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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394501630
Report Date: 07/08/2026
Date Signed: 07/08/2026 11:40:15 AM

Document Has Been Signed on 07/08/2026 11:40 AM - 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:CAPSLO-ADELITA CENTERFACILITY NUMBER:
394501630
ADMINISTRATOR/
DIRECTOR:		ELIZABETH RICOFACILITY TYPE:
860
ADDRESS:14320 EAST HARNEY LANETELEPHONE:
(209) 368-2087
CITY:LODISTATE: CAZIP CODE:
95240
CAPACITY: 74TOTAL ENROLLED CHILDREN: 74CENSUS: 34DATE:
07/08/2026
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:35 AM
MET WITH:Elizabeth RicoTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 7/08/2026, Licensing Program Analyst (LPA) Sarah met with Director, Elizabeth Rico, for the purpose of an unannounced Annual inspection. Facility days and hours of operation are Monday through Friday from 5:30 AM to 4:00 PM. There were 9 staff supervising 4 infants, 10 toddlers, and 20 preschoolers. The Director was reminded never to exceed the conditions, limitations and capacity specified on the license.

All staff present during today's inspection have a fingerprint clearance. Director 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 tour of the facility and the file review were done previously on 7/6/26.

LPA toured the facility, including all activity and classroom spaces, restrooms, food service and outdoor play areas. LPA reviewed care and supervision of children, safe sleep, staffing ratios, medications and first aid supplies, furniture, equipment, fire drills, menus and drinking water. LPA observed all required forms to be posted. There are no bodies of water on the premises. The facility has at least one functioning carbon monoxide detector. The facility provides breakfast, lunch, and snack to children in care.

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NAME OF LICENSING PROGRAM MANAGER: Bettina Engelman
NAME OF LICENSING PROGRAM ANALYST: Sarah Tibbett
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/08/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: CAPSLO-ADELITA CENTER
FACILITY NUMBER: 394501630
VISIT DATE: 07/08/2026
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Infant Activity Space:

LPA observed 2 infants sleeping while in care. LPA observed 15 min sleeping logs and individual sleeping plans for infants present. Montessori bed boxes were available for each infant under 12 months old, the facility has a waiver on file. A Needs and Services Plan was on file for each infant present during today’s inspection. LPA observed proper storage of milk and formula that were dated and labeled with children's names, the facility provides bottles. There were appropriate toys and equipment available for infants under 18 months. LPA observed a changing table within arm's reach of the sink. LPA toured the outdoor play area and discussed removing loose gravel. LPA observed shade through trees and shade covers.

LPA discussed the safe sleep regulations with Director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and- resources/safe-sleep as an additional resource. LPA also informed the Director of the importance of checking for and removing any recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Toddler Activity Space:

LPA observed 6 toddlers in care. LPA observed 15 minute sleeping checks for all toddlers under 24 months. There were age appropriate toys and equipment available for all toddlers enrolled. Outdoor space was toured and separate from preschool. Playground equipment and surfaces were inspected and are in good condition. Shade was provided via trees and shade covers.

LPA observed that hazardous items (disinfectants, cleaning solutions etc.) were inaccessible to children in care. LPA observed cleaning solutions were kept separate from the stored food items in the kitchen. All furnishings were in good condition. Bathrooms were clean and all sinks and toilets were in operating condition. There are adequate toys and equipment available for children.

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NAME OF LICENSING PROGRAM MANAGER: Bettina Engelman
NAME OF LICENSING PROGRAM ANALYST: Sarah Tibbett
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2026
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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: CAPSLO-ADELITA CENTER
FACILITY NUMBER: 394501630
VISIT DATE: 07/08/2026
NARRATIVE
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Preschool Activity Space:

LPA observed 14 children in care. There are adequate toys and equipment available for children. Outdoor play area was toured. Playground equipment and surfaces were inspected and are in good condition with enough turf for cushioning and trees and shade covers for shade. LPA observed that hazardous items (disinfectants, cleaning solutions etc.) were inaccessible to children in care. LPA observed cleaning solutions were kept separate from the stored food items in the kitchen. All furnishings were in good condition. Bathrooms were clean and all sinks and toilets were in operating condition. There are adequate toys and equipment available for children.

LPA observed fire drills are being conducted and discussed conducting one at least once every six months. LPA observed that children are being properly signed in and out. Children and staff files were reviewed. Each file contained all required documents, including immunizations. At least one staff member present today had current Pediatric CPR and First Aid. LPA observed AB1207 Mandated Reporter training certificates for all staff files reviewed. The Facility was reminded to renew the course every 2 years through www.mandatedreporterca.com website.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22- 02-CCP. When any IMS is provided, a Plan for Providing 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: https://www.ada.gov/resources/child-care-centers/.To improve the quality and value of the new inspection process, a survey will be sent to the email address provided.

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NAME OF LICENSING PROGRAM MANAGER: Bettina Engelman
NAME OF LICENSING PROGRAM ANALYST: Sarah Tibbett
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2026
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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: CAPSLO-ADELITA CENTER
FACILITY NUMBER: 394501630
VISIT DATE: 07/08/2026
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To improve the quality and value of the new inspection process, a survey may 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.

Exit interview conducted and report was reviewed with the director, Elizabeth Rico. Appeal Rights were provided. A notice of site visit was also provided and must remain posted for 30 days. Failure to comply with posting requirements will result in an immediate civil penalty of $100

LPA Tibbett informed Director, Elizabeth Rico, that this report dated 7/08/26 documents 1 Type-A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Tibbett informed the Director to provide a copy of this licensing report dated 7/08/26 that documents any Type-A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

NAME OF LICENSING PROGRAM MANAGER: Bettina Engelman
NAME OF LICENSING PROGRAM ANALYST: Sarah Tibbett
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/08/2026 11:40 AM - It Cannot Be Edited


Created By: Sarah Tibbett On 07/08/2026 at 09:07 AM
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: CAPSLO-ADELITA CENTER
FACILITY NUMBER: 394501630

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/08/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/08/2026
Section Cited
CCR
101439.1(f)

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(f) Cribs shall be free from all loose articles and objects, including blankets and pillows.
This requirement was not met as evidenced by: On 7/06/26, LPA observed a sleeping infant in a Montessori bed box wrapped loosely in a blanket.
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LPA observed the teacher remove the blanket from the sleeping infant. LPA provided a copy of the Safe Sleep PIN 20-24-CCP to the Director to review with staff. LPA requested for Director to send a confirmation that it was reviewed with staff.
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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.
Bettina Engelman
NAME OF LICENSING PROGRAM MANAGER:
Sarah Tibbett
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/08/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/08/2026


LIC809 (FAS) - (06/04)
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