SAY - JEFFERSON EXTENDED DAY PROGRAM

Type B citation - potential risk if not corrected

Type B citation - potential risk if not corrected

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25On 09/28/21, at 3:30PM, LPA, Luigi Gargaro, conducted an unannounced case management visit to the facility. Visit was conducted to deliver citation for violation of facility using classroom, room 208, that was not previously inspected and approved by Licensing. Analyst was not able to issue citation at time of previous 08/31/21 visit but issued it during today's return visit to address the violation. The classroom has otherwise been found to appropriately furnished and accommodated and has been approved for use. Analyst had Site Supervisor Skinner sign today's report and then printed a copy of it and facility appeal rights for her records. SUPERVISORS NAME: Jason Garay LICENSING EVALUATOR NAME: Luigi Gargaro LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2021 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2021 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 FACILITY NAME: SAY - JEFFERSON EXTENDED DAY PROGRAM FACILITY NUMBER: 376701088 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 09/28/2021 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 09/28/2021 Section Cited CCR 101173(c) 1 2 3 4 5 6 7101173 Plan Of Operation (c) Any proposed changes in the plan of operation that affect services to children shall be subject to departmental approval prior to implementation and shall be reported as specified in Section 101212. This requirement was not met as evidenced by:1 2 3 4 5 6 7Classroom was approved after the completion of the 08/31/21 inspection but site supervisor and program director understand that licensing is to be informed of any potential changes in operations at the facility and must receive their approval prior to them occurring 8 9 10 11 12 13 14Based on analyst observation, during 08/31/21 case management visit, program had started using classroom 208 prior to it being inspected and approved by the department. Making changes to the operation of a facility prior to advising licensing and obtaining their approval is a potential risk to children in care.8 9 10 11 12 13 14 1 2 3 4 5 6 71 2 3 4 5 6 7 1 2 3 4 5 6 71 2 3 4 5 6 7 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:Jason Garay LICENSING EVALUATOR NAME:Luigi Gargaro LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2021 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2021

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25On 09/28/21, at 3:30PM, LPA, Luigi Gargaro, conducted an unannounced case management visit to the facility. Visit was conducted to deliver citation for violation of facility using classroom, room 208, that was not previously inspected and approved by Licensing. Analyst was not able to issue citation at time of previous 08/31/21 visit but issued it during today's return visit to address the violation. The classroom has otherwise been found to appropriately furnished and accommodated and has been approved for use. Analyst had Site Supervisor Skinner sign today's report and then printed a copy of it and facility appeal rights for her records. SUPERVISORS NAME: Jason Garay LICENSING EVALUATOR NAME: Luigi Gargaro LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2021 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2021 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 FACILITY NAME: SAY - JEFFERSON EXTENDED DAY PROGRAM FACILITY NUMBER: 376701088 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 09/28/2021 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 09/28/2021 Section Cited CCR 101173(c) 1 2 3 4 5 6 7101173 Plan Of Operation (c) Any proposed changes in the plan of operation that affect services to children shall be subject to departmental approval prior to implementation and shall be reported as specified in Section 101212. This requirement was not met as evidenced by:1 2 3 4 5 6 7Classroom was approved after the completion of the 08/31/21 inspection but site supervisor and program director understand that licensing is to be informed of any potential changes in operations at the facility and must receive their approval prior to them occurring 8 9 10 11 12 13 14Based on analyst observation, during 08/31/21 case management visit, program had started using classroom 208 prior to it being inspected and approved by the department. Making changes to the operation of a facility prior to advising licensing and obtaining their approval is a potential risk to children in care.8 9 10 11 12 13 14 1 2 3 4 5 6 71 2 3 4 5 6 7 1 2 3 4 5 6 71 2 3 4 5 6 7 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:Jason Garay LICENSING EVALUATOR NAME:Luigi Gargaro LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2021 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2021

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25On 09/28/21, at 3:30PM, LPA, Luigi Gargaro, conducted an unannounced case management visit to the facility. Visit was conducted to deliver citation for violation of facility using classroom, room 208, that was not previously inspected and approved by Licensing. Analyst was not able to issue citation at time of previous 08/31/21 visit but issued it during today's return visit to address the violation. The classroom has otherwise been found to appropriately furnished and accommodated and has been approved for use. Analyst had Site Supervisor Skinner sign today's report and then printed a copy of it and facility appeal rights for her records. SUPERVISORS NAME: Jason Garay LICENSING EVALUATOR NAME: Luigi Gargaro LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2021 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2021 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 FACILITY NAME: SAY - JEFFERSON EXTENDED DAY PROGRAM FACILITY NUMBER: 376701088 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 09/28/2021 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 09/28/2021 Section Cited CCR 101173(c) 1 2 3 4 5 6 7101173 Plan Of Operation (c) Any proposed changes in the plan of operation that affect services to children shall be subject to departmental approval prior to implementation and shall be reported as specified in Section 101212. This requirement was not met as evidenced by:1 2 3 4 5 6 7Classroom was approved after the completion of the 08/31/21 inspection but site supervisor and program director understand that licensing is to be informed of any potential changes in operations at the facility and must receive their approval prior to them occurring 8 9 10 11 12 13 14Based on analyst observation, during 08/31/21 case management visit, program had started using classroom 208 prior to it being inspected and approved by the department. Making changes to the operation of a facility prior to advising licensing and obtaining their approval is a potential risk to children in care.8 9 10 11 12 13 14 1 2 3 4 5 6 71 2 3 4 5 6 7 1 2 3 4 5 6 71 2 3 4 5 6 7 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:Jason Garay LICENSING EVALUATOR NAME:Luigi Gargaro LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2021 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2021

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25On 09/28/21, at 3:30PM, LPA, Luigi Gargaro, conducted an unannounced case management visit to the facility. Visit was conducted to deliver citation for violation of facility using classroom, room 208, that was not previously inspected and approved by Licensing. Analyst was not able to issue citation at time of previous 08/31/21 visit but issued it during today's return visit to address the violation. The classroom has otherwise been found to appropriately furnished and accommodated and has been approved for use. Analyst had Site Supervisor Skinner sign today's report and then printed a copy of it and facility appeal rights for her records. SUPERVISORS NAME: Jason Garay LICENSING EVALUATOR NAME: Luigi Gargaro LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2021 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2021 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 FACILITY NAME: SAY - JEFFERSON EXTENDED DAY PROGRAM FACILITY NUMBER: 376701088 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 09/28/2021 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 09/28/2021 Section Cited CCR 101173(c) 1 2 3 4 5 6 7101173 Plan Of Operation (c) Any proposed changes in the plan of operation that affect services to children shall be subject to departmental approval prior to implementation and shall be reported as specified in Section 101212. This requirement was not met as evidenced by:1 2 3 4 5 6 7Classroom was approved after the completion of the 08/31/21 inspection but site supervisor and program director understand that licensing is to be informed of any potential changes in operations at the facility and must receive their approval prior to them occurring 8 9 10 11 12 13 14Based on analyst observation, during 08/31/21 case management visit, program had started using classroom 208 prior to it being inspected and approved by the department. Making changes to the operation of a facility prior to advising licensing and obtaining their approval is a potential risk to children in care.8 9 10 11 12 13 14 1 2 3 4 5 6 71 2 3 4 5 6 7 1 2 3 4 5 6 71 2 3 4 5 6 7 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:Jason Garay LICENSING EVALUATOR NAME:Luigi Gargaro LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2021 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2021