313611140-9-6-2023-03-CC-LHAM-CVER2J-20230906123825

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 313611140
Report Date: 09/06/2023
Date Signed: 09/06/2023 12:38:31 PM

Document Has Been Signed on 09/06/2023 12:38 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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	KIDS PARK		FACILITY NUMBER:	313611140
ADMINISTRATOR:	GIGI HARVEL		FACILITY TYPE:	850
ADDRESS:	6801 FIVE STAR BOULEVARD		TELEPHONE:	(916) 624-2344
CITY:	ROCKLIN	STATE: CA	ZIP CODE:	95677
CAPACITY: 15	TOTAL ENROLLED CHILDREN: 15	CENSUS: 17	DATE:	09/06/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Gigi Harvel		TIME COMPLETED:	12:50 PM

NARRATIVE

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On Wednesday, September 6. 2023 Licensing Program Analysts (LPAs) Lea Habtom and Tanya Washington met with designated representative Alyssa Bair for the purpose of an unannounced 1 year required inspection. During the inspection, Gigi Harvel, arrived and assisted LPAs with the inspection. The facility is a drop in center. Hours of operation is Mon-Thur 8 am- 8pm, Fri 8 am- 10 pm, Sat 10 am- 10 pm and Sun 11 am- 6 pm. The facility offers lunch, dinner & 3 snacks. Upon arrival there were 16 preschool children present with one more being dropped off and 1 school age child. There were three staff present. The facility has a waiver for a fluctuating capacity based on how many school age children are in care at the time. LPAs toured the facility.

A health and safety inspection were conducted in the classrooms, restrooms, and food service areas. LPA observed the following documents are posted: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, menus, and daily schedule. Cleaning disinfectants and hazardous items are appropriately stored and inaccessible to children. Medications are stored, inaccessible to children. Furniture and equipment are in good condition, and toileting facilities are in sanitary, and operating condition. Bins for solid waste in the kitchen have tight fitting lids. The floors appeared clean throughout the Children bring their own labeled water bottles. Facility provides lunch and snack. LPA observed a functional carbon monoxide detector.

LPA reviewed staff files. CPR expired end of August and staff are registered for the next available course on September 10, 2023. LPA observed immunization records and documentation of the educational background, training, and/or experience. One staff is missing TB. LPA advised AB 1207 Mandated Reporter training must be renewed every two years and can be renewed at www.mandatedreporterca.com. (Report continues 809-C)

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023

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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: KIDS PARK	FACILITY NUMBER: 313611140
	VISIT DATE: 09/06/2023

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Children's records were reviewed.

Facility representative 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual-Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/(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.html

One Title 22 regulation was cited during today's inspection. Exit interview conducted and report was reviewed with the facility representative Gigi Harvel. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

To improve the quality and value of the new inspection process, a survey will 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

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/06/2023 12:38 PM - It Cannot Be Edited

Created By: Lea Habtom On 09/06/2023 at 11:44 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: KIDS PARK	FACILITY NUMBER: 313611140
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101217(a)(12)

Personnel Records

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (12) Tuberculosis test documents as specified in Section 101216(g). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in that 1 staff is missng proof of tuberculosis which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/06/2023
	Plan of Correction
1 2 3 4	Director, Gigi, agreed to email proof of tuberculosis to LPA Lea Habtom by POC due date of 10/6/2023.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Keven Peters

LICENSING EVALUATOR NAME:

Lea Habtom

LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023

LIC809 (FAS) - (06/04)

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