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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 034500943
Report Date: 12/11/2023
Date Signed: 12/11/2023 11:31:23 AM

Document Has Been Signed on 12/11/2023 11:31 AM - 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: 30CENSUS: DATE:
12/11/2023
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Site Director, MichelleTIME COMPLETED:
11:45 AM
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Licensing Program Manager (LPM) Chayntel Hunter, and Licensing Program Analyst (LPA) Elizabeth Santiago met with Director, Michelle Loffswold for the purpose of an Informal Meeting. LPM Hunter defined an Informal Meeting. LPM advised Ms. Michelle the purpose of today’s meeting is to help provider gain compliance and prevent future occurrences.

Today's informal meeting was to discuss the incident that occurred on 11/28/2023 where a child bit into a medicine capsule, and the facility did not seek medical attention, nor was the parent promptly notified of the incident.

The facility was previously cited on 01/20/2023 for reporting requirements where a child fell off a play structure and sustained a concussion, and parents were not promptly notified. There was also an unsubstantiated complaint in which it was alleged that staff did not obtain emergency medical care for the daycare child.

The Licensee stated that they have taken the following steps to maintain compliance:

Reporting Requirements: Director implemented a poison protocol which outlines that the facility will:
1. Immediately wash out the child’s mouth
2. Call the facility’s local poison control
3. Call child’s parents
4. Call 911, if necessary

LPA and LPM reviewed regulations on Supervision, Health related services and Reporting Requirements.
Continues on LIC809-C...
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Elizabeth Santiago
LICENSING EVALUATOR SIGNATURE: DATE: 12/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/11/2023
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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: GOLD STAR PRESCHOOL
FACILITY NUMBER: 034500943
VISIT DATE: 12/11/2023
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LPM and LPA provided information regarding training videos on Health and Safety and the Technical Support Program (TSP), which is a non-enforcement arm of the Community Care Licensing Division offering onsite support to licensees and providers. LPM discussed using the Department website (ccld.ca.gov) for child care updates, legislation, forms and regulation information. LPM suggested viewing information videos at www.ccld.childcarevideos.org.

This report was reviewed by Director, Michelle Loffswold.
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Elizabeth Santiago
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2023
LIC809 (FAS) - (06/04)
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