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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624916
Report Date: 10/22/2024
Date Signed: 10/22/2024 12:14:21 PM

Document Has Been Signed on 10/22/2024 12:14 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:MISSION AVENUE PRESCHOOLFACILITY NUMBER:
343624916
ADMINISTRATOR/
DIRECTOR:		CHRISTINA DIAZ BUSHMANFACILITY TYPE:
830
ADDRESS:2433 MISSION AVENUETELEPHONE:
(916) 487-4647
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 19TOTAL ENROLLED CHILDREN: 19CENSUS: 6DATE:
10/22/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Nicole Moran EstradaTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On Tuesday October 22nd 2024, Licensing Program Analyst (LPA) Mandie Goodwin met with Director Nicole Moran Estrada for the purpose of an unannounced random inspection. LPA toured the facility at which time a census of 6 infants supervised by 2 staff members were observed. During inspection ratios were adhered to and facility was operating within the capacity specified on the license.

LPA observed that each child had a Needs and Services plan. LPA observed an Individual Infant Sleeping Plan (LIC9227) for each child under 12 months of age. LPA observed documentation that sleep checks were being conducted by staff every 15 minutes. Bottles were kept in refrigerators inside the kitchen and were properly labeled with the child's name and date. All furnishings were in good condition. Infant diaper changing area is clean. Changing table was observed to be within arm’s reach from sink. There is a mat for the changing table with a vinyl surface that is at least 1 inch thick and has raised sides. Toys are appropriate size with no small parts for the safety of the infants.



The infant classrooms appeared clean including the carpets and floor. Chemicals and cleaning materials were kept inaccessible to children. Playground equipment and surfaces were inspected and are in good condition with enough resilient material under climbing structures to absorb a fall. There are no firearms or bodies of water on the premises and the facility has at least one functioning smoke and carbon monoxide detector. LPA observed the appropriate postings were visible to parents and that children were signed in and out of the center. LPA observed a current roster and record that fire drills are being conducted at least every 6 months. Per record the last fire drill was conducted on 10/17/24.

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. LPA advised AB 1207 Mandated Reporter training must be renewed every two years and can be renewed at www.mandatedreporterca.com. Continued on 809-C

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Mandie Goodwin
LICENSING EVALUATOR SIGNATURE: DATE: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/22/2024
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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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: MISSION AVENUE PRESCHOOL
FACILITY NUMBER: 343624916
VISIT DATE: 10/22/2024
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A sample of 6 children's records were reviewed. Each child's file contained an emergency card, consent for emergency medical treatment, health history, a record of immunization’s and notifications of children’s and parent’s rights.

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.

Director 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 licensee to the Department website for lead. Lead Toxicity Prevention and Water Testing Information- https://www.cdss.ca.gov./inforesources/child-care-licesing/water-testing-information.

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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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/. Continued on 809-C

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

DATE: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024
LIC809 (FAS) - (06/04)
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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: MISSION AVENUE PRESCHOOL
FACILITY NUMBER: 343624916
VISIT DATE: 10/22/2024
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Director 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 Director Nicole Moran Estrada. Based on the areas evaluated, no title 22 deficiencies were cited today. 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: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024
LIC809 (FAS) - (06/04)
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