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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623422
Report Date: 07/24/2024
Date Signed: 07/24/2024 03:08:04 PM

Document Has Been Signed on 07/24/2024 03:08 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/
DIRECTOR:		MANCHESTER, ANGELINAFACILITY TYPE:
850
ADDRESS:1941 ZINFANDEL DRIVETELEPHONE:
(916) 706-2653
CITY:RANCHO CORDOVASTATE: CAZIP CODE:
95670
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: 23DATE:
07/24/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:35 AM
MET WITH:Danielle LawTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Erwina Pascual-Golamco, met with Director, Danielle Law, for a case management inspection regarding an incident on 07/10/24. Purpose of the inspection was explained.

Director self reported and submitted a written Unusual Incident Report LIC624, that on 07/10/24, a staff member left children unattended in the play yard at two instances. According to Director, 1st was approximately 1 minute and the 2nd was longer than the first, approximately 2 to 5 minutes. According to Director, staff took a child indoors twice, leaving other children unattended in the play yard. Staff members informed Director about the incident, and Director investigated, interviewed staff and witnesses and took necessary actions.

Based on interview and record reviews, Title 22 Deficiency has been issued on the attached LIC 809-D page. Director was informed that the Type A deficiency cited today is an immediate civil penalty, for absence of supervision, and is being assessed in the amount of $500. Director 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. Exit interview was conducted with Director, appeal rights were provided, and A notice of site visit was given Director, who will post it where visible to parents/guardians for 30 days. A signed Acknowledgement of Receipt of the Licensing Report (LIC9224) must be placed in the child's file for verification.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE: DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/24/2024
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 2
Document Has Been Signed on 07/24/2024 03:08 PM - It Cannot Be Edited


Created By: Erwina Pascual-Golamco On 07/24/2024 at 10:46 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: BUILDING KIDZ OF RANCHO CORDOVA
FACILITY NUMBER: 343623422

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/25/2024
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision (a)The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time...shall include visual observation.
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Director stated staffing changes have occurred since incident and current staff were reminded never to leave children unattended. Deficiency cleared at time of visit.
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This requirement is not met as evidenced by:based on interview, and record reviews, Director (D) did not comply with the section cited above as a children were left unsupervised in the play yard at two instances. D stated that a staff took a child indoors, leaving other children in their care in the play yard unsupervised, which poses an immediate 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:Natalie Dunaway
LICENSING EVALUATOR NAME:Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE:
DATE: 07/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/24/2024


LIC809 (FAS) - (06/04)
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