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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623893
Report Date: 10/08/2024
Date Signed: 10/08/2024 02:35:52 PM

Document Has Been Signed on 10/08/2024 02:35 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 CITRUS HEIGHTSFACILITY NUMBER:
343623893
ADMINISTRATOR/
DIRECTOR:		ILIYAH DEMAFELIZFACILITY TYPE:
850
ADDRESS:8073 GREENBACK LNTELEPHONE:
(916) 735-3165
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 15DATE:
10/08/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Icee LawsonTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
NARRATIVE
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On October 08, 2024, Licensing Program Analyst (LPA) Stephanie Piring met with the facility representative, Icee Lawson, for a case management inspection. Upon LPAs arrival, there were 15 napping children in care with one teacher. The director was on lunch but shortly returned.

During today’s inspection, LPA reviewed staff records. LPA observed all staff currently employed with the facility have a criminal record clearance, current Pediatric CPR and First Aid certification, current AB1207 Mandated Reporter Training, and documentation of their educational background, training, and/or experience. Of the 3 files reviewed, LPA observed a helath screening missing for two staff employed and immunization records missing for one staff. LPA Provided guidance on required director trainings.

Based on inspection, see LIC 809-D for deficiency cited today. Copy of this report was reviewed and provided to the facility representative. Notice of site visit was provided and shall remain posted for next 30 days.

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Stephanie Piring
LICENSING EVALUATOR SIGNATURE: DATE: 10/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/08/2024
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 10/08/2024 02:35 PM - It Cannot Be Edited


Created By: Stephanie Piring On 10/08/2024 at 02:12 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 CITRUS HEIGHTS
FACILITY NUMBER: 343623893

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/08/2024
Section Cited
HSC
1596.7995(a)(1)

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(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
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Facility Representative will send proof of Measles and pertussis to LPA by 4pm on POC due date
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Based on record review, the licensee did not comply with the section cited above in that one staff is missing proof of measles and pertussis which poses/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:Natalie Dunaway
LICENSING EVALUATOR NAME:Stephanie Piring
LICENSING EVALUATOR SIGNATURE:
DATE: 10/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/08/2024


LIC809 (FAS) - (06/04)
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