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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343625085
Report Date: 08/11/2023
Date Signed: 08/11/2023 11:21:02 AM

Document Has Been Signed on 08/11/2023 11:21 AM - 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:GENIUS KIDS PRESCHOOLFACILITY NUMBER:
343625085
ADMINISTRATOR:SADISHKUMAR, KOTHAIFACILITY TYPE:
850
ADDRESS:2800 LA LOMA DRIVETELEPHONE:
(925) 998-0385
CITY:RANCHO CORDOVASTATE: CAZIP CODE:
95670
CAPACITY: 58TOTAL ENROLLED CHILDREN: 58CENSUS: 27DATE:
08/11/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Kothai SadishkumarTIME COMPLETED:
11:45 AM
NARRATIVE
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On August 11, 2023, Licensing Program Analyst (LPA) Erwina Pascual-Golamco, met with Administrator, Kothai Sadishkumar (A1), and Director, Tiani Fant (D1) for a case management inspection regarding an incident that happened on 8/4/23. Census included 27 preschool children supervised by 5 staff. Purpose of the inspection was explained.

The facility submitted a written Unusual Incident Report LIC624, that on 8/4/23, a child was left in play yard without supervision for about 17 minutes that the LPA received on 8/10/23. LPA asked A1 and D1 why it was not reported to the department the next working day, in addition to the written LIC624, and A1 and D1 stated they were not aware of the requirement of notifying the department the next working day. During today's inspection, LPA inspected the classrooms and play yard and interviewed staff, A1 and D1. D1 stated that staff did not take roll and did not follow Genius Kids policy regarding roll calls. D1 stated staff have been retrained on ratios, reviewed employee handbook, and Genius Kids policies/rules, child supervision and transition from classroom to play yard. A1 stated the facility has developed a sign in and out form for staff to check children back inside the classroom from the play yard. Deficiency cleared at time of visit.

Based on observation, interview, and record reviews, Title 22 Deficiencies have been issued on the attached LIC 809-D page. A1 and D1 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. A1 and D1 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 A1 and D1, appeal rights were provided, and A notice of site visit was given to A1 and D1, who will post it where visible to parents/guardians for 30 days. A signed Acknowledgement of Receipt of the Licensing Report (LIC 9224) must be placed in the child's file for verification.

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE: DATE: 08/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/11/2023
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 08/11/2023 11:21 AM - It Cannot Be Edited


Created By: Erwina Pascual-Golamco On 08/11/2023 at 10:24 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: GENIUS KIDS PRESCHOOL
FACILITY NUMBER: 343625085

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/11/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/14/2023
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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D1 stated staff have been retrained on ratios, reviewed employee handbook, and Genius Kids policies/rules, child supervision and transition from classroom to play yard.

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This requirement is not met as evidenced by:based on observation, interview, and record reviews, D1 did not comply with the section cited above as a child was left unsupervised in the play yard for about 17 minutes. D1 stated that staff did not follow policy regarding roll calls, which poses an immediate health, safety, or personal rights risk to persons in care.
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 A1 stated the facility has developed a sign in and out form for staff to check children back inside the classroom from the play yard. Deficiency cleared at time of visit.

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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: 08/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/11/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/11/2023 11:21 AM - It Cannot Be Edited


Created By: Erwina Pascual-Golamco On 08/11/2023 at 10:37 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: GENIUS KIDS PRESCHOOL
FACILITY NUMBER: 343625085

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/11/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/25/2023
Section Cited
CCR
101212(d)(1)(C)

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101212 Reporting Requirements (d)...any of the events specified in (d)(1) below, a report shall be made to the dept. by telephone or fax within the dept...next working day...In addition, a written report...submitted...to the dept...within seven days...(C)Any unusual incident ...that threatens...or safety of any child.
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LPA reminded A1 and D1 of the reporting requirements, and provided a copy of the manual. D1 and A1 will email LPA attestation statement that they understand the requirement and will comply moving forward by 4PM of POC due date.
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This requirement is not met as evidenced by:based on observation, interview, and record reviews, D1 did not comply with the section cited above as incident on 8/4/23 was not reported to the dept. the next working day, which poses 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:Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE:
DATE: 08/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/11/2023


LIC809 (FAS) - (06/04)
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