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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 573622545
Report Date: 08/02/2022
Date Signed: 08/02/2022 12:33:46 PM

Document Has Been Signed on 08/02/2022 12:33 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:ACADEMY 4 KIDS (PS)FACILITY NUMBER:
573622545
ADMINISTRATOR:BARRAGAN, PATRICIA & BARRAFACILITY TYPE:
850
ADDRESS:2455 WEST CAPITOL AVE, #110TELEPHONE:
(916) 389-0843
CITY:WEST SACRAMENTOSTATE: CAZIP CODE:
95691
CAPACITY: 28TOTAL ENROLLED CHILDREN: 28CENSUS: DATE:
08/02/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Patricia Barragan TIME COMPLETED:
10:00 AM
NARRATIVE
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On August 2, 2022, at approximately 9:30AM ,Licensing Program Analyst (LPA) Stacey Williams conducted a case management inspection at the facility. LPA observed children (27) twenty seven children supervised by four staff. During the inspection LPA observed preschool children commingled with school age children in the outdoor play area. The facility holds a separate license for school age and preschool children.

Title 22 deficiency has been cited on subsequent page, LIC 809D. Upon receipt of Type A citations, facility shall post and provide copies of the LIC 809D for parents/guardians of children currently in care and for parents/guardians of newly enrolled children for the next 12 months. Facility must also keep the signed LIC 9224, acknowledging receipt of Licensing Reports LIC 809D in each child's files.

An exit interview was conducted, and a Plan of Correction was reviewed and developed with the Facility Representative, Patricia Barragan. A copy of this report and appeal rights were discussed and left the Facility Representative. 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: 08/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/02/2022
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 08/02/2022 12:33 PM - It Cannot Be Edited


Created By: Stacey Williams On 08/02/2022 at 12:17 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
, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: ACADEMY 4 KIDS (PS)
FACILITY NUMBER: 573622545

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/02/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/03/2022
Section Cited
CCR
101161(a)

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A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation.
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Director stated that she will submit a written plan to address how school age and preschool children will no longer be commingled both inside and outside of the facility. The plan will be submitted to CCL by plan of correction date- 8/3/22.
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This requirement was not met as evidenced by: LPA observed seven school age children commingled with preschool aged children in the outdoor play area of the facility. This poses an immediate 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: 08/02/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/02/2022


LIC809 (FAS) - (06/04)
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