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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 573622546
Report Date: 07/22/2021
Date Signed: 07/22/2021 03:49:13 PM

Document Has Been Signed on 07/22/2021 03:49 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 (SA)FACILITY NUMBER:
573622546
ADMINISTRATOR:BARRAGAN, PATRICIA & BARRAFACILITY TYPE:
840
ADDRESS:2455 WEST CAPITOL AVE, #110TELEPHONE:
(916) 389-0843
CITY:WEST SACRAMENTOSTATE: CAZIP CODE:
95691
CAPACITY: 7TOTAL ENROLLED CHILDREN: 0CENSUS: 7DATE:
07/22/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Patricia Barragan & Erica BarraganTIME COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Marissa Soto met with owner Director Patricia Barragan and co-owner Teacher Erica Barragan for a Case Management Inspection.

Deficiencies were observed and are cited on the subsequent pages (809-D) of this report.

Facility Representative shall post 809-D with Type A deficiency for 30 days and provide copies of this licensing report to parents/guardians of children during the next 12 months.

Notice of Site Visit was posted.

An exit interview was conducted in which Appeal Rights were provided and explained to Facility representative.
SUPERVISORS NAME: Maria Mayorga
LICENSING EVALUATOR NAME: Marissa Soto
LICENSING EVALUATOR SIGNATURE: DATE: 07/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/22/2021
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 07/22/2021 03:49 PM - It Cannot Be Edited


Created By: Marissa Soto On 07/22/2021 at 02:22 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 (SA)
FACILITY NUMBER: 573622546

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/22/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/23/2021
Section Cited
CCR
101216(i)

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Criminal Record Clearance:101216(i) Prior to employment or inital presence in the child care center, all employees and volunteers subject to a criminal record review shall obtain a California clearance.
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Director stated the uncleared adult will be working in the kitchen. Director stated she will have the uncleared adult live scanned for criminal record clearance and associate her to the facility.
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This requirement was not met as by evidence: LPAs observed an adult working in the facility without a criminal record clearance. This is a immediate risk to the children in care.
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Licensee will submit verification of live scan to LPA Soto by POC Date: 7/23/21.

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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:Maria Mayorga
LICENSING EVALUATOR NAME:Marissa Soto
LICENSING EVALUATOR SIGNATURE:
DATE: 07/22/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/22/2021


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/22/2021 03:49 PM - It Cannot Be Edited


Created By: Marissa Soto On 07/22/2021 at 02:46 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 (SA)
FACILITY NUMBER: 573622546

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/22/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/09/2021
Section Cited
CCR
101217(a)

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Personal Records: The Licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee.
This requirement was not met as evidence by: No personnel records were available for staff #1 Staff #2 and Staff 3. This poses as a potential risk to health and safety of the children.
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Facility representative stated that she will ensure that all staff records are ready and avaiable.

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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:Maria Mayorga
LICENSING EVALUATOR NAME:Marissa Soto
LICENSING EVALUATOR SIGNATURE:
DATE: 07/22/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/22/2021


LIC809 (FAS) - (06/04)
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