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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 550318064
Report Date: 08/29/2024
Date Signed: 08/29/2024 03:57:11 PM

Document Has Been Signed on 08/29/2024 03:57 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:BELLEVIEW SCHOOLFACILITY NUMBER:
550318064
ADMINISTRATOR/
DIRECTOR:		KIMBERLY ANGELFACILITY TYPE:
850
ADDRESS:22736 KEWIN MILL ROADTELEPHONE:
(209) 586-5510
CITY:SONORASTATE: CAZIP CODE:
95370
CAPACITY: 24TOTAL ENROLLED CHILDREN: 6CENSUS: 5DATE:
08/29/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Elisa LuceraTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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On 08/29/24, Licensing Program Analyst (LPA) Elvira Sierra met with Preschool Site Supervisor, Elisa Lucera for the purpose of an unannounced annual inspection. Facility representative was reminded never to exceed the conditions, limitations and capacity specified on the license. Facility is a State preschool program that operates inside Belleview Elementary School grounds in classroom #2. Hours of operation are M-F from 08:00 a.m to 11:30 a.m. Facility follows school district calendar year. Upon arrival present in the facility were two staff members supervising five children. Per facility representative staff working at the facility are fingerprinted through the Tuolumne County Superintended of School Office.
LPA conducted a health and safety inspection in all areas accessible to children and the following was observed; Appropriate ratio and care and supervision were observed during today's inspection. Classroom is adequately ventilated/heated. LPA observed age-appropriate toys and equipment that are in good repair. Toxic and hazardous items were inaccessible to children. LPA observed dual functioning carbon/monoxide detectors and a 2A10BC fire extinguisher that follows California State Fire Marshall standards. Per facility representative there are no poisons on the premises and no bodies of water were observed. The floors appeared clean throughout the facility. Toileting facilities were observed in safe, sanitary, and operating condition. First Aid Kit and Emergency supplies are available and stored inaccessible to children. No children that required medication at this time. Outdoor activity space surface is maintained in a safe condition and is free of hazards. Playground equipment was observed to be in good repair and areas around high climbing equipment, swings and slides have cushioning material to absorb falls. Drinking water is readily available indoor and outdoor by drinking fountains and also children bring their personal water bottles.
Facility provides lunch for the children. Menus were posted accessible to parents. All posting requirements has been met. Emergency/disaster drill are conducted monthly jointly with the elementary school and facility does keep a log documenting drill practice. LPA reviewed five children and two staff files, and current CPR/ First aid card for staff. Sign in/out sheets were reviewed. Report continues on subsequent page 809C---
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: BELLEVIEW SCHOOL
FACILITY NUMBER: 550318064
VISIT DATE: 08/29/2024
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Facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.



Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) 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).
Per facility representative and School Superintended, Carmel Portillo facility had a water test for lead done last year and documents will be provided to Licensing by 09/06/24,
Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

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 CARE tools, please send email inquiries 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/inspection-process.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with facility representative, Eliza Lucera.

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024
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Document Has Been Signed on 08/29/2024 03:57 PM - It Cannot Be Edited


Created By: Elvira Sierra On 08/29/2024 at 03:11 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: BELLEVIEW SCHOOL
FACILITY NUMBER: 550318064

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/29/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101212(b)
Reporting Requirements
(b) The name of the child care center director, and any fully qualified teacher(s) designated to act in the child care center director's absence, shall be reported to the Department within 10 days of a change of child care center director or designee(s).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on records review the licensee did not comply with the section cited above by not reporting the information for the new Director and designee or Site Supervisor which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/30/2024
Plan of Correction
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Facility will submit all required documents to assign the new Program Director and Site Supervisor. During today's inspection LPA verified that both Superintendednt and Site Supervisor are qualified.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Elvira Sierra
LICENSING EVALUATOR SIGNATURE:
DATE: 08/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/29/2024


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