Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343610864
Report Date: 11/03/2017
Date Signed 11/03/2017 03:07:42 PM

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:FAMILY MATTERS EARLY LEARNING CENTER/ PRESCHOOLFACILITY NUMBER:
343610864
ADMINISTRATOR:NELSON, GINAFACILITY TYPE:
850
ADDRESS:5452 14TH AVETELEPHONE:
(916) 457-4067
CITY:SACRAMENTOSTATE: CAZIP CODE:
95820
CAPACITY:42CENSUS: 25DATE:
11/03/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Danielle RobertsTIME COMPLETED:
03:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Mary Ponce met with Director Danielle Roberts for an unannounced annual inspection. Today’s census was 25 children and 5 staff members, who have all been finger-print cleared through Community Care Licensing. LPA toured the facility including all activity/classroom areas, food service area and restrooms. LPA observed that furniture and equipment are in good condition, the food preparation area is kept clean and sanitized; however there was expired food in the refrigerator which could be a potential risk to the children.The restrooms are safe and sanitary. The Director stated that the facility provided morning/afternoon snack and lunch; LPA observed a current menu posted in front sign in area.

LPA observed that at least one staff member present during today’s inspection has a current Pediatric CPR/First Aid that expires on 9/11/18. LPA observed that poisons are locked, cleaning compounds are inaccessible to children and the Director stated there are no firearms or bodies of water on the property. LPA reviewed care and supervision of children and staffing ratios, there is one teacher for every 12 children in care. LPA observed that medications are centrally stored and inaccessible to children; however there was expired medication which could pose a potential risk to the children. LPA reviewed children’s files and observed that each child had their Identification/Emergency Information and the Consent for Medical Treatment form filled out and signed by their authorized representative. LPA also reviewed staff's educational background /transcripts, and the facility has the appropriate staffing that meet the educational requirements. LPA observed that outdoor activity space surfaces are free of hazards, playground equipment is in safe condition and drinking water is made readily available to children both indoors and outdoors.
SUPERVISOR'S NAME: Monica R FiliceTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Mary PonceTELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2017
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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: FAMILY MATTERS EARLY LEARNING CENTER/ PRESCHOOL
FACILITY NUMBER: 343610864
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/03/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/30/2017
Section Cited
HSC
1597.622
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Immunizations. Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home 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
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POC: Director states that she will obtain immunizastion records for all staff and volunteers and will provide LPA with copies by the POC date.
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and December 1 of each year.
LPA did not observe immunization records in any staff files that show immunization for MMR and DTAP.
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Type B
11/30/2017
Section Cited
CCR
101227(a)(1)
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In child care centers providing meals to children, the following shall apply: All food shall be safe and of the quality and in the quantity necessary to meet the needs of the children. Each meal shall include, at a minimum, the amount of food components as specified by Title 7, Code
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POC: Director states she will impliment a check off system that required staff to ensure there is no expired food in the fridge. Director will submit written check off list or newly implimented procedures to LPA by 11/30/17
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of Federal Regulations, Part 226.20, (Revised January 1, 1990) Requirements for Meals, for the age group served. All food shall be selected, stored, prepared and served in a safe and healthful manner.
LPA Observed expired beef and tortillas in the refrigerator
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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: Monica R FiliceTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Mary PonceTELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2017
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2017
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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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: FAMILY MATTERS EARLY LEARNING CENTER/ PRESCHOOL
FACILITY NUMBER: 343610864
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/03/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/30/2017
Section Cited
CCR
101226(e)(3)(A)
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health related services (e) In centers where the licensee chooses to handle medications: (3) Prescription medications may be administered if all of the following conditions are met: (A) Prescription medications shall be administered in accordance with the label directions as
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POC: Director states she will return medication to parents and will obtain a current prescription. Director will submit proof of new prescription or letter from parents stating they no longer use the medication to LPA by POC Due date.
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prescribed by the child's physician.

LPA observed expired medication in the medication lock box that belonged to child #2
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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: Monica R FiliceTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Mary PonceTELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2017
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2017
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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: FAMILY MATTERS EARLY LEARNING CENTER/ PRESCHOOL
FACILITY NUMBER: 343610864
VISIT DATE: 11/03/2017
NARRATIVE
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LPA discussed Departments inspection authority regulations with the Director and informed her that if any changes occur regarding the Designee/Director or an employee acting in their absence must be reported to Department within 10 working days. LPA also discussed Unusual Incident Reports (UIRs) and reporting requirements. LPA informed the Director that if any unusual incidents occur she must contact the Department within 24 hours and an UIR must be submitted with 7 day, describing the specifics to the incident.
LPA provided the Community Care Licensing’s website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA advised the licensee of their responsibility to stay current in regards to new regulations.

LPA discussed the new Immunization Regulations SB 792, the requirement that all individuals working or volunteering at a licensed Child Care facility must have vaccinations against, Pertussis, Measles and Influenza LPA advised the licensee that they can sign a declaration to be exempt from the influenza vaccinations however; Pertussis and Measles are not exemptible. To be exempt from Pertussis and Measles staff must have a medical exemption signed by a licensed physician.

LPA conducted file reviews and observed that the staff does not have proof that they have been immunization against Measles, Pertussis or Influenza, which is a potential risk to children in care. LPA advised the licensee that if the staff cannot obtain their shot records they can take a blood test to check for immunity or they can get the vaccinations again..

IMS
This facility plans to provide IMS, LPA advised the licensee that IMS information can be found in the Evaluator Manual/Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and the Medication Regulations 101226. A Plan of Operation that includes IMS must be submitted to LPA. LPA provided the following information regarding ADA: US Department of Justice (USDOJ), ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: www.ada.gov/childqanda
In the areas that were evaluated, 3 deficiencies were cited during the visit. LPA read this report to the licensee, she stated understands today’s inception. Appeal Rights were provided and Notice of Site Visit posted and the license understands it must remain posted for 30 days.
SUPERVISOR'S NAME: Monica R FiliceTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Mary PonceTELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2017
LIC809 (FAS) - (06/04)
Page: 2 of 4