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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343616190
Report Date: 08/13/2024
Date Signed: 08/13/2024 01:34:35 PM

Document Has Been Signed on 08/13/2024 01:34 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:BUSY BEE CHILDHOOD DEVELOPMENT CENTERFACILITY NUMBER:
343616190
ADMINISTRATOR/
DIRECTOR:		JUDITH DOMONDONFACILITY TYPE:
850
ADDRESS:1618 27TH STREETTELEPHONE:
(916) 457-7348
CITY:SACRAMENTOSTATE: CAZIP CODE:
95816
CAPACITY: 82TOTAL ENROLLED CHILDREN: 82CENSUS: 68DATE:
08/13/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Heather JohnsonTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
NARRATIVE
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On 8/13/2024 at 12:45p.m., Licensing Program Analysts (LPA) Pa Dao Vang met with Assistant Director, Heather Johnson, for a Case Management inspection regarding an Unusual Incident Report submitted to our regional office on 8/9/2024. Upon arrival, LPA observed 68 preschoolers supervised by 11 staff.

It was reported on 8/9/2024 approximately at 9:00a.m., C1 was climbing the structure in the playground, when he fell on to the wood chips outside. C1 broke two bones in the left wrist. Parent were contacted and picked up C1 to the hospital on the same day. According to staff interviews, a teacher was nearby supervising, saw the incident occurred, and attended to the C1 immediately.

During today's inspection LPA toured the facility, made observations, and inspected the playground area. LPA inspected the cushioning area under the play structure, in which there were dirt under the wood chips exposed in several areas of the climbing structure. LPA observed in some areas with mats on top of the wood chips for children. In the area inspected today, LPA learned it was about a year ago when wood chips were refilled under the climbing structures.

Based on LPA observations and interviews conducted, a deficiency is being cited on page LIC809-D page in accordance with the California Code of Regulations, Title 22. This report was reviewed with Assistant Director, Heather Johnson. A copy of this report, appeal rights, and a notice of site visit was provided to be posted for 30 consecutive days.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Dao Vang
LICENSING EVALUATOR SIGNATURE: DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/13/2024
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 08/13/2024 01:34 PM - It Cannot Be Edited


Created By: Dao Vang On 08/13/2024 at 01:21 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: BUSY BEE CHILDHOOD DEVELOPMENT CENTER
FACILITY NUMBER: 343616190

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/13/2024
Section Cited
CCR
101238.2(e)

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(e) As a condition of licensure, the areas around and under high climbing equipment, swings, slides and other similar equipment shall be cushioned with material that absorbs falls.

This requirement is not met as evidenced by:
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Director will provide photo evidence of filled wood chip cushioning or will provide documentation of purchase/work order by POC due date.
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Based on observation, the licensee did not comply with the section cited above as the wood chip cushioning was low and the dirt are exposed in several areas, which posed a potential health, safety or personal rights risk to persons 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:Seychelle De Luca
LICENSING EVALUATOR NAME:Dao Vang
LICENSING EVALUATOR SIGNATURE:
DATE: 08/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/13/2024


LIC809 (FAS) - (06/04)
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