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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093605023
Report Date: 05/20/2026
Date Signed: 05/20/2026 02:07:33 PM

Document Has Been Signed on 05/20/2026 02:07 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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:CAMINO HEAD START/STATE PRESCHOOLFACILITY NUMBER:
093605023
ADMINISTRATOR/
DIRECTOR:		PEREZ, MARGARITAFACILITY TYPE:
850
ADDRESS:3060 SNOWS ROADTELEPHONE:
(530) 295-4512
CITY:CAMINOSTATE: CAZIP CODE:
95709
CAPACITY: 24TOTAL ENROLLED CHILDREN: 17CENSUS: 16DATE:
05/20/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:10 PM
MET WITH:Karrie FieriTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
NARRATIVE
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On Wednesday, May 20,2026, Licensing Program Analyst (LPA) Sala Vang met with Karrie Fieri (LR) for the purpose of an unannounced required annual inspection. Upon arrival, LPA observed a census of 16 children supervised by 3 staff. Licensee Representative was reminded never to exceed the condition, limitations and capacity specified on the license. All individuals subject to criminal background review have obtained a criminal record clearance. Facility hours of operation are Monday through Friday, 08:30 AM to 03:00 PM.

LPA toured classroom space and outdoor play area. LPA observed the following documents are posted: License, Parents' Rights Poster, Seat Belt Law, Menu, Daily Schedule, and Lead Testing Certification. LPA observed a functional carbon monoxide detector and full 2-A-10-BC fire extinguisher. LPA observed authorized representatives are using full legal signatures on the sign in and out sheet. LPA observed a children’s roster and fire drill log. Facility has record of conducting fire drills at least every six months. The last fire drill was conducted on April 16, 2026.

Cleaning disinfectants and hazardous items are appropriately stored and inaccessible to children. LP stated there is no poison or firearms on the premises. LPA advised the applicant that all poisons must be locked with a key lock or combination lock. Furniture and equipment are in good condition, and toileting facilities are in safe, sanitary, and operating condition. Trash bins have tight-fitting lids. Medications and first aid supplies are stored in a central location. Food preparation space was hygienic, and all food protected against contamination. Menu items were posted for breakfast, lunch and PM snacks provided by the facility.

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NAME OF LICENSING PROGRAM MANAGER: Jeevun Birk-Miller
NAME OF LICENSING PROGRAM ANALYST: Ye Vang
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/20/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 05/20/2026 02:07 PM - It Cannot Be Edited


Created By: Ye Vang On 05/20/2026 at 01:46 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: CAMINO HEAD START/STATE PRESCHOOL
FACILITY NUMBER: 093605023

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/20/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(g)(2)
Personnel Requirements
(2) Each person specified in (g) above shall have a health-screening report signed by the person performing the screening. This report shall indicate the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 1 out of 3 staff which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/20/2026
Plan of Correction
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Admin will work on obtaining the health screening documentation and submit to LPA.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Jeevun Birk-Miller
NAME OF LICENSING PROGRAM MANAGER:
Ye Vang
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/20/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/20/2026


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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: CAMINO HEAD START/STATE PRESCHOOL
FACILITY NUMBER: 093605023
VISIT DATE: 05/20/2026
NARRATIVE
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Playground equipment and surfaces are free of loose or sharp parts and provide sufficient cushioning. There are sufficient equipment and toys, and shaded areas, there is no bodies of water on the premises. Uncontaminated drinking water was readily available to children both indoors and outdoors.

LPA reviewed present staff files. At least one staff member present today has current Pediatric CPR/First Aid certification which expires on 11/2026. Two of three staff currently present and currently employed with the facility have: a criminal record clearance, a health screening report, immunization records, current mandate reporter training, and documentation of their educational background, training, and/or experience. LPA advised AB1207 Mandate Reporter training must be renewed every two years and can be renewed at www.mandatereporterca.com/california. One staff is missing their health screening. A sample of 6 children’s records were reviewed. Each child’s files contained an emergency card, consent for medical treatment, health history, a record of immunization's, and notification or personal and parent right.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test as specified in Health and Safety Code
section 1597.16. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP.). LPA verified that the lead testing was completed in accordance to the Written Directives (Interim Licensing Standards) outlined in PIN 21-21.1-CCP. LPA referred licensee representative to the Department website for lead: Lead Toxicity Prevention and Water Testing Information (https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information)

CCC COMPLETED TESTING AND NO LEAD EXCEEDANCES

Licensee representative was reminded that all adults 18 and over, 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.

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NAME OF LICENSING PROGRAM MANAGER: Jeevun Birk-Miller
NAME OF LICENSING PROGRAM ANALYST: Ye Vang
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2026
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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: CAMINO HEAD START/STATE PRESCHOOL
FACILITY NUMBER: 093605023
VISIT DATE: 05/20/2026
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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. 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 are available at: https://www.ada.gov/resources/child-care-centers/.

Licensee representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee Representative, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

One Type B deficiency were cited during today's inspection.

This report was reviewed with LP, Appeal Rights and A Notice of Site Visit (NOS) was provided to LP, who will post it for a period of 30 days for parental review.

Exit interview conducted and report was reviewed with the licensee representative Karrie Fieri.
NAME OF LICENSING PROGRAM MANAGER: Jeevun Birk-Miller
NAME OF LICENSING PROGRAM ANALYST: Ye Vang
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2026
LIC809 (FAS) - (06/04)
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