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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500315
Report Date: 09/22/2021
Date Signed: 09/22/2021 01:29:41 PM

Document Has Been Signed on 09/22/2021 01:29 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:ACADEMY OF CHILD DEVELOPMENT AND AMOREFACILITY NUMBER:
394500315
ADMINISTRATOR:AIDA LOMELIFACILITY TYPE:
850
ADDRESS:170 EAST FRENCH CAMPTELEPHONE:
(209) 898-2958
CITY:FRENCH CAMPSTATE: CAZIP CODE:
95231
CAPACITY: 40TOTAL ENROLLED CHILDREN: 0CENSUS: 9DATE:
09/22/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Aida LomeliTIME COMPLETED:
01:15 PM
NARRATIVE
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During the course of a complaint investigation Licensing Program Analyst (LPA) Christopher Jackson observed two of the preschool children playing in an area of the center that was separated from the other areas of the room, creating a lack of supervision. LPA discussed with the owner that children must remain in line of sight of staff.

Deficiencies cited on subsequent 809-D page.

Licensee acknowledges, that, FOR TYPE A DEFICIENCIES ONLY, upon receipt, licensee shall post this report with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. The LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the licensee (LIC 9224 was provided).

An exit interview was conducted and Notice of Site Visit was provided and posted.
SUPERVISORS NAME: Justin L Denton
LICENSING EVALUATOR NAME: Christopher Jackson
LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2021
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 09/22/2021 01:29 PM - It Cannot Be Edited


Created By: Christopher Jackson On 09/22/2021 at 12:26 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
, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: ACADEMY OF CHILD DEVELOPMENT AND AMORE
FACILITY NUMBER: 394500315

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/22/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/23/2021
Section Cited
CCR
101229(1)(a)

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No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This was not met as evidenced by,
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Licensee stated they would hire addtional staff and substitue staff will be brought in to ensure supervision requirements are met.
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LPA observed children palying in area not with an obstructed view from the teacher. This poses and immediate health and safety risk to chldren 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:Justin L Denton
LICENSING EVALUATOR NAME:Christopher Jackson
LICENSING EVALUATOR SIGNATURE:
DATE: 09/22/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/22/2021


LIC809 (FAS) - (06/04)
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