313623889-4-4-2023-03-CC-MGAO-CQKULX-20230404154128

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 313623889
Report Date: 04/04/2023
Date Signed: 04/04/2023 03:42:27 PM

Document Has Been Signed on 04/04/2023 03:42 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:	KIDS' PLACE, THE		FACILITY NUMBER:	313623889
ADMINISTRATOR:	GAROFALO, LAUREN		FACILITY TYPE:	850
ADDRESS:	1115 COMBIE RD		TELEPHONE:	(530) 878-7875
CITY:	MEADOW VISTA	STATE: CA	ZIP CODE:	95722
CAPACITY: 11	TOTAL ENROLLED CHILDREN: 11	CENSUS: 7	DATE:	04/04/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	Lauren Garofalo		TIME COMPLETED:	03:40 PM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

At approximately 1:40pm, Licensing Program Analysts (LPAs) Matthew Gallo and Jeremey McClain met with Director Lauren Garofalo for the purpose of an unannounced annual random inspection. Census included 7 preschool children being supervised by 1 staff. Director was reminded never to exceed the conditions, limitations and capacity specified on the license. Facility hours of operation are 7am-6pm Monday-Friday. Facility does not offer transportation services.

LPA toured the building including all activity and classroom spaces, restrooms, food service and outdoor play areas. All required forms were posted. Director stated and LPAs observed no poisons, firearms, or pools of water on the premises. All toxic and hazardous items were inaccessible to children. Functional carbon dioxide detector and smoke detector were present. Furniture and equipment were in good condition, and the floors appeared clean throughout the facility. Playground surfaces were free of loose or sharp parts, and the areas underneath or around climbing equipment were sufficiently cushioned with granulated rock. However, the main green wooden play structure in the yard has wood rot and fraying wood in areas children play on. Sufficient napping equipment was available.

Snack food is prepared off-site and provided in the morning and afternoon. Storage containers with solid waste had tight-fitting covers. Program provides daily snacks, and menus were posted in visible sight. Drinking water bottles are brought from home and facility has uncontaminated water cooler as alternative source. LPA observed full legal signatures while reviewing the sign in and sign out sheet as required for infant age component. Medication was properly stored and inaccessible to children.

Report Continued on 809-C

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE:	DATE: 04/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 3

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: KIDS' PLACE, THE	FACILITY NUMBER: 313623889
	VISIT DATE: 04/04/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Staff and children's records were reviewed. Each child's file was complete and contained all necessary forms and documents. Review of staff records confirmed at least one staff member present today has current Pediatric CPR and First Aid certification, and that all staff currently employed with the facility have a criminal record clearance, health screening report, documentation of the educational background, training, and/or experience, and valid AB1207 Manded Reporter Training certificates. 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. LPA reviewed the Department's inspection authority and discussed with designee any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

Title 22 deficiencies are cited on the subsequent pages of this report.

Licensee acknowledges, that FOR TYPE A DEFICIENCIES ONLY upon receipt, licensee shall post LIC 809D with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

Exit interview conducted and report was reviewed with the facility representative Lauren Garofalo. Appeal rights and notice of site visit provided, the latter of which must be posted for 30 days. Failure to comply with posting requirements will result in an immediate $100 civil penalty.

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE:	DATE: 04/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

Document Has Been Signed on 04/04/2023 03:42 PM - It Cannot Be Edited

Created By: Matthew Gallo On 04/04/2023 at 03:17 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: KIDS' PLACE, THE	FACILITY NUMBER: 313623889
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/04/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101238.2(d)(2)

Outdoor Activity Space

(d) The surface of the outdoor activity space shall be maintained: (2) Free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in the case of a wooden structure on the play yard that contains wood rot and fraying wood in areas where the children play, thus posing a potential health and safety hazard to the children.
	POC Due Date: 05/01/2023
	Plan of Correction
1 2 3 4	Director will have the play structure removed and will send LPA Gallo pictures as evidence

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:

Matthew Gallo

LICENSING EVALUATOR SIGNATURE:

DATE: 04/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2023

LIC809 (FAS) - (06/04)

Page: 3 of 3