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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343616702
Report Date: 05/02/2024
Date Signed: 05/02/2024 01:12:44 PM

Document Has Been Signed on 05/02/2024 01:12 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:CAMELLIA PRESCHOOLFACILITY NUMBER:
343616702
ADMINISTRATOR/
DIRECTOR:		HAMMOND, ALYCEFACILITY TYPE:
850
ADDRESS:6600 COUGAR DRIVETELEPHONE:
(916) 395-4520
CITY:SACRAMENTOSTATE: CAZIP CODE:
95828
CAPACITY: 25TOTAL ENROLLED CHILDREN: 25CENSUS: 16DATE:
05/02/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:15 AM
MET WITH:Reena SharmaTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
NARRATIVE
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On Thursday May 2nd 2024, Licensing Program Analyst (LPA) Mandie Goodwin met with Site Supervisor Reena Sharma for the purpose of an unannounced random inspection. Operating hours of the facility are from 8:00 am to 2:30 pm, Monday thru Friday. Classroom operates out of Room 1 on the Camellia Campus. LPA toured the classroom at which time a census of 16 preschool children supervised by 3 staff members were observed. LPA observed that the listed Director “Alyce Hammond” is no longer at the facility and a new director was not reported. There is a qualified site supervisor on site.

A health and safety inspection was conducted in the classroom, restroom, food service area, and outdoor play area. LPA observed all postings. Cleaning disinfectants and hazardous items are appropriately stored and inaccessible to children. There were no medications stored at the facility at time of visit. Furniture and equipment are in good condition, and toileting facilities are in sanitary and operating condition. There are bins for solid waste. The floors appeared clean throughout the facility. LPA observed functional smoke and carbon monoxide detectors, and a serviced fire extinguisher. Nap equipment was stored appropriately with bedding separated. LPA observed a current roster, documentation of sign in and sign outs, and documentation that facility is conducting emergency disaster drills at least every 6 months. Per record the last fire drill was conducted 4/25/24.

Children have access to water indoors and outdoors by bringing water bottles which are refilled. Playground equipment and surfaces are free of loose or sharp parts. LPA observed sufficient cushioning of bark. Outdoor shade is provided by trees, and sides of buildings. There are no firearms or bodies of water on the premises. Director stated there are no poisons on the premises.

LPA reviewed present staff files. At least one staff member present today has current Pediatric CPR and First Aid certification. LPA observed immunization records and documentation of the educational background, training, and/or experience. (Report continues 809-C)

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Mandie Goodwin
LICENSING EVALUATOR SIGNATURE: DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/02/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 05/02/2024 01:12 PM - It Cannot Be Edited


Created By: Mandie Goodwin On 05/02/2024 at 12:29 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: CAMELLIA PRESCHOOL
FACILITY NUMBER: 343616702

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/02/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101212(b)
Reporting Requirements
(b) The name of the child care center director, and any fully qualified teacher(s) designated to act in the child care center director's absence, shall be reported to the Department within 10 days of a change of child care center director or designee(s).

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 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/16/2024
Plan of Correction
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Facility will designate the on-site director that oversees the classroom and send the name of director and a complete director packet to LPA by the above POC date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Mandie Goodwin
LICENSING EVALUATOR SIGNATURE:
DATE: 05/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/02/2024


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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: CAMELLIA PRESCHOOL
FACILITY NUMBER: 343616702
VISIT DATE: 05/02/2024
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Upon review, all staff members had current mandated reporter trainings. LPA advised AB 1207 Mandated Reporter training must be renewed every two years and can be renewed at www.mandatedreporterca.com.

A sample of 5 children's records were reviewed and observed to be complete. LPA provided and reviewed the Child Care Center Entrance Checklist.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Site Supervisor was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA referred facility representative to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

Representative showed LPA documentation of lead testing that was completed in 2017 and cleared. Per written directives lead testing must be completed on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test. A technical violation was assessed.

LPA discussed the safe sleep regulations with Director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. Report continues on 809-C

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Mandie Goodwin
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024
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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: CAMELLIA PRESCHOOL
FACILITY NUMBER: 343616702
VISIT DATE: 05/02/2024
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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Site Supervisor Reena Sharma. Based on the areas evaluated, a type B title 22 deficiency was cited today. Appeal rights were provided. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Mandie Goodwin
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024
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