<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 034500943
Report Date: 09/28/2023
Date Signed: 09/28/2023 03:38:20 PM

Document Has Been Signed on 09/28/2023 03:38 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:GOLD STAR PRESCHOOLFACILITY NUMBER:
034500943
ADMINISTRATOR:LOFFSWOLD, MICHELLEFACILITY TYPE:
850
ADDRESS:190 FOGARTY RDTELEPHONE:
(209) 256-8059
CITY:SUTTER CREEKSTATE: CAZIP CODE:
95685
CAPACITY: 30TOTAL ENROLLED CHILDREN: 16CENSUS: 0DATE:
09/28/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Michelle LoffswoldTIME COMPLETED:
12:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Centralized Application Bureau (CAB) Licensing Program Analyst (LPA) Alecia Sifuentes and Licensing Program Analyst (LPA) Mariya Melnichuk met with Licensee Michelle Loffswold for the purpose of an announced pre-licensing change of location inspection. Licensee requests a preschool license to serve 30 preschool children from age two to entry into kindergarten. The program will operate Monday through Friday from 7:30 a.m. to 5:30 p.m. The fire clearance was received and granted on 9/1/2023. The facility will provide morning snack, lunch, and afternoon snacks.

LPA reviewed with applicant the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

INDOOR ACTIVITY SPACE:
There is one large preschool classroom and library area. AS observed a sufficient amount of equipment, toys, tables, chairs, cubbies, and napping cots. There is a first aid kit in the kitchen in the wall medicine box. Medications will be stored in the kitchen in the fridge. AS observed cleaning disinfectants are appropriately stored in the kitchen and inaccessible to children. Licensee stated there are no poisons or firearms on the premises. AS observed a water station with a water pitcher and cups next to the kitchen. AS observed a functional carbon monoxide detector near the kitchen. AS observed a sign in/sign out binder. Licensee plans to go electronic.

AS measured the classroom. The total classroom space contains a total of 3,383 square feet, which will accommodate Licensee's request for 30 preschool children. There are 3 toilets and 2 sinks for the children, and a separate private restroom for the staff located at the end of the hallway. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Children who become ill during the day will be isolated in the office area and will use the staff restroom, if necessary.

Report continues on LIC809-C.
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2023
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: GOLD STAR PRESCHOOL
FACILITY NUMBER: 034500943
VISIT DATE: 09/28/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
OUTDOOR ACTIVITY SPACE:
There is one outdoor area on the property. The outdoor play area is fenced with a wooden fence and concrete wall/iron fencing. The overall fencing is at least four feet tall, however LPA's observed that two sections of the fencing has a gab of seven inches and eleven inches. Licensee will fill the gaps with large rocks and send LPA photos of completion. AS observed a sufficient amount of equipment and toys. There is no play structure. There are no bodies of water on the premises. There are shaded areas supplied by canopy/tarp and overhangs.

AS measured the outdoor activity space. The outdoor play area contains a total of 1,209 square feet, which will only accommodate 16 preschool children. Licensee has requested an Insufficient Outdoor Space Waiver and has provided outdoor scheduled times. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

AS discussed the following: 100% supervision is required at all times, including in the bathroom; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. AS discussed with Licensee any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

Licensee was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

Report continues on LIC809-C.
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: GOLD STAR PRESCHOOL
FACILITY NUMBER: 034500943
VISIT DATE: 09/28/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Licensee was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the Licensee, Michelle Loffswold.

The following item is required before a license will be issued:
1. Photos of the fencing barricade.
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3