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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093622019
Report Date: 05/10/2023
Date Signed: 05/10/2023 02:54:25 PM

Document Has Been Signed on 05/10/2023 02:54 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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:CAMERON PARK MONTESSORI SCHOOL, INC.FACILITY NUMBER:
093622019
ADMINISTRATOR:BEEMAN, KIMBERLY ANNEFACILITY TYPE:
850
ADDRESS:4140 MOTHERLODE DR. SUITE 100TELEPHONE:
(530) 677-1776
CITY:SHINGLE SPRINGSSTATE: CAZIP CODE:
95682
CAPACITY: 56TOTAL ENROLLED CHILDREN: 56CENSUS: 28DATE:
05/10/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Kimberly BeemanTIME COMPLETED:
03:15 PM
NARRATIVE
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Licensing Program Analysts Erwina Pascual-Golamco and Jennifer Velasco (LPA) met with Director Kimberly Beeman for an unannounced annual inspection. LPA toured the facility, including all activity and classroom spaces, restrooms, and outdoor play areas. Census included 28 preschool children being supervised by 3 classroom staff. Director was reminded never to exceed the conditions, limitations, and capacity specified on the license. Facility hours of operation are Monday through Friday from 7:00AM to 5:00PM.

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.



Classrooms are clean, including floors, and are free from hazards. Technical Violation was given regarding chemicals accessible to children. LPA observed the door leading to chemicals was unlocked, and cleaning products containing bleach were on the floor next to the door. LPA provided technical assistance and staff rendered the closet inaccessible during visit. Playground equipment and surfaces were inspected and are in good condition. Technical Assistance was provided regarding resilient material under climbing structures to cushion fall. Director stated parents provide snack and lunch for their children and bring their own water bottles from home.

Bathrooms were observed and all sinks and toilets were sanitary and in operating condition. There are no firearms or bodies of water on the premises and the facility has at least one functioning smoke and carbon monoxide detector. LPA observed all required licensing documentation was posted for parental review. Technical Assistance provided regarding signing children in and out of the center.

continued...

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE: DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/10/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: CAMERON PARK MONTESSORI SCHOOL, INC.
FACILITY NUMBER: 093622019
VISIT DATE: 05/10/2023
NARRATIVE
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Children’s and staff’s files were reviewed. Children and Staff files had missing licensing documentation and not available for LPA review. LPA did not observe a current Pediatric CPR and First Aid certification with staff. LPA observed a current a fire drill log conducted on 1/21/.23. There is First Aid equipment available.

Incidental Medical Services (IMS) were discussed. Technical assistance was provided as 3 out of 3 IMS did not have prescriptions or instructions. For additional IMS information, Director was advised to see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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: http://www.ada.gov/childqanda.htm.

FR was encouraged to the visit the department's website at WWW.CCLD.CA.GOV for information regarding childcare updates, PINs, forms, regulations and legislation pertaining to childcare centers.

Title 22 deficiencies were cited during today's inspection and are documentation on continuation page LIC809 D. This report was reviewed with FR, and an exit interview was conducted. Appeal Rights were provided. A Notice of Site Visit (NOS) was provided to FR, who will post it for a period of 30 days for parental review.

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/10/2023 02:54 PM - It Cannot Be Edited


Created By: Erwina Pascual-Golamco On 05/10/2023 at 11:59 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
, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: CAMERON PARK MONTESSORI SCHOOL, INC.
FACILITY NUMBER: 093622019

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/10/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in 3 out of 3 staff members did not have a current mandated reported and 2 out of 3 files were not avavilble for review which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/24/2023
Plan of Correction
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Director will email certificate and proof of completion to LPA erwina.pascual-golamco@dss.ca.gov by POC due date 5/24/23.
Type B
Section Cited
CCR
101216(f)
Personnel Requirements
(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in 3 out of 3 staff did not have a current first aid/CPR which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/24/2023
Plan of Correction
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Director will email proof of enrollment to LPA erwina.pascual-golamco@dss.ca.gov by POC due date 5/24/23. Director to email certificate to LPA upon completion.
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:Natalie Dunaway
LICENSING EVALUATOR NAME:Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE:
DATE: 05/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/10/2023


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Document Has Been Signed on 05/10/2023 02:54 PM - It Cannot Be Edited


Created By: Erwina Pascual-Golamco On 05/10/2023 at 11:59 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
, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: CAMERON PARK MONTESSORI SCHOOL, INC.
FACILITY NUMBER: 093622019

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/10/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101217(d)
Personnel Records
(d) All personnel records shall be maintained at the child care center and shall be available to the licensing agency for review.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in 2 out of 3 staff files were incomplete/missing which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/24/2023
Plan of Correction
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Director will provide LPA with missing documents of staff by email by 5/24/23 erwina.pascual-golamco@dss.ca.gov.
Type B
Section Cited
CCR
101221(b)(10)
Child's Records
(b) Each record shall contain information including, but not limited to, the following: (10) Record of current medications, including the name of the prescribing physician, and instructions, if any, regarding control and custody of medications.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in 3 out of 3 children's inhalers did not have labeled presciptions, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/24/2023
Plan of Correction
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Director will obtain prescription and instructions for all IMS. Director will email documents to LPA erwina.pascual-golamco@dss.ca.gov by 5/24/23.
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:Natalie Dunaway
LICENSING EVALUATOR NAME:Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE:
DATE: 05/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/10/2023


LIC809 (FAS) - (06/04)
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