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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623422
Report Date: 09/20/2023
Date Signed: 09/20/2023 06:01:21 PM

Document Has Been Signed on 09/20/2023 06:01 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:BUILDING KIDZ OF RANCHO CORDOVAFACILITY NUMBER:
343623422
ADMINISTRATOR:MANCHESTER, ANGELINAFACILITY TYPE:
850
ADDRESS:1941 ZINFANDEL DRIVETELEPHONE:
(916) 706-2653
CITY:RANCHO CORDOVASTATE: CAZIP CODE:
95670
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: 14DATE:
09/20/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Danielle LawTIME COMPLETED:
01:45 PM
NARRATIVE
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On 09/20/23 at approximately 11:00 AM, Licensing Program Analyst (LPA) Erwina Pascual-Golamco, met with current Director Danielle Law. The purpose of today's inspection was discussed with the Licensee. During the visit, LPA observed 14 children supervised by 2 staff members. Current Director Danielle Law, came in the facility a few minutes after LPA arrived at the facility. During today's visit, LPA observed 1 staff member present in the facility without a criminal background clearance. Based on record review, LPA found that the staff member was not cleared through the Guardian System. Based on record review and interviews it was determined that the staff member worked at the facility just for today to cover ratios.

Based on the inspection and record review, a Type A Title 22 Deficiency have been issued on the attached LIC 809-D page. A civil penalty is being assessed in the amount of $100 for Caregiver Background Check. The Licensee shall also provide a copy of this licensing report to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report.

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. A signed Acknowledgement of Receipt of the Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. Exit interview was conducted, and the Director has been provided with appeal rights.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2023
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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Document Has Been Signed on 09/20/2023 06:01 PM - It Cannot Be Edited


Created By: Erwina Pascual-Golamco On 09/20/2023 at 12:30 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: BUILDING KIDZ OF RANCHO CORDOVA
FACILITY NUMBER: 343623422

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/20/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/21/2023
Section Cited
CCR
101216(i)(1)

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101216 Personnel Requirements:
(i) Prior to employment or initial presence in the child care center, all employees and volunteers subject to a criminal record review shall:(1)Obtain a California clearance or a criminal record exemption as required by law...
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Director came in as the uncleared staff left the facility to maintain ratio. Deficiency cleared at time of visit.
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This requirement is not met as evidenced by LPA's record review, interviews, and observation of the presence of one working staff member who have not obtained criminal background clearance, which poses an immediate health and safety risk to children 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:Natalie Dunaway
LICENSING EVALUATOR NAME:Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE:
DATE: 09/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/20/2023


LIC809 (FAS) - (06/04)
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