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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500429
Report Date: 10/16/2024
Date Signed: 10/16/2024 03:04:39 PM

Document Has Been Signed on 10/16/2024 03:04 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:ACADEMY OF CHILD DEVELOPMENT & AMOREFACILITY NUMBER:
394500429
ADMINISTRATOR/
DIRECTOR:		AIDA LOMELIFACILITY TYPE:
830
ADDRESS:170 EAST FRENCH CAMP ROADTELEPHONE:
(209) 898-2958
CITY:FRENCH CAMPSTATE: CAZIP CODE:
95321
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 3DATE:
10/16/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Katheryne DouglassTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
NARRATIVE
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On October 16, 2024, Licensing Program Analysts (LPAs), Lauren Scott and Janie Davis, conducted an unannounced field visit to the facility. LPA toured the facility and observed three (3) infants unsupervised. Based on observation, facility did not ensure supervision guidelines were met per title 22 regulations in three(3) children in care of the facility, which poses an immediate health, safety or personal rights risk to persons in care.

One Type A violation was assessed on a subsequent 809-D page. An exit interview was conducted, and the report was reviewed with the Director. Appeal Rights were provided to. A Notice of Site visit was posted by LPA and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

LPA informed facility representative, Katheryne Douglass that this report dated 10/16/24 documents one Type A citation. Type A citations which shall be posted for 30 consecutive days as there is an immediate risks to the health, safety, or personal rights of children in care.

Also, LPA informed the facility representative the need to provide a copy of this licensing report dated 10/16/24 that documents any Type A citations 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. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

An exit interview was conducted with Facility Representative Katheryne Douglass. Facility Representative was given a copy of Appeal Rights. A notice of Site Visit was posted by the LPA and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Janie Davis
LICENSING EVALUATOR SIGNATURE: DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/16/2024
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 10/16/2024 03:04 PM - It Cannot Be Edited


Created By: Janie Davis On 10/16/2024 at 01:57 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: ACADEMY OF CHILD DEVELOPMENT & AMORE
FACILITY NUMBER: 394500429

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/17/2024
Section Cited
CCR
101229(a)(1)

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(a) The licensee shall provide care and supervision... Supervision shall include visual observation.

This requirement is not met as evidenced by:
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Facility will conduct a staff meeting reviewing guidelines of supervision and sleeping infants with signatures emailed to Licensning Program Analyst LPA by POC date.
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LPA observed three (3) sleeping infants behind a closed door in the nap room with no teacher present in the room with them, which poses an immediate health, safety or personal rights risk to persons in care. ABSENCE OF SUPERVISION/ CIVIL PENALTIES ASSESSED.
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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:Chayntel Hunter
LICENSING EVALUATOR NAME:Janie Davis
LICENSING EVALUATOR SIGNATURE:
DATE: 10/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/16/2024


LIC809 (FAS) - (06/04)
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