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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093605882
Report Date: 03/30/2023
Date Signed: 03/30/2023 10:52:00 AM

Document Has Been Signed on 03/30/2023 10:52 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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:KERSEY, CINDYFACILITY NUMBER:
093605882
ADMINISTRATOR:KERSEY, CINDYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 337-9482
CITY:CAMERON PARKSTATE: CAZIP CODE:
95682
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
03/30/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Cindy KerseyTIME COMPLETED:
11:00 AM
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Licensing Program Analysts (LPA) Erwina Pascual-Golamco met with licensee, Cindy Kersey, for an unannounced annual inspection. During the inspection there was a census of 10 preschool aged CHILDREN being supervised by the licensee and assistant. All individuals subject to criminal background review have obtained a criminal record clearance. Facilities hours of operation are Tuesdays and Thursdays 9am – 12 nn.

Health and safety inspection were conducted in the areas accessible to children. The off-limit areas include: garage, upstairs, and north side of yard. The stairs are fenced or barricaded. Licensee understands that children may never enter these off-limits areas. The house has a working telephone, fully charged fire extinguisher, smoke detector and carbon monoxide detector that meet regulations. LPA observed all required postings. LPA observed home is orderly, and free of hazards. LPA informed the licensee that poisons, detergents, cleaning compounds, medicines, and other items which could pose a danger to children shall be stored, locked, and inaccessible to children. LPA observed a fireplace within the home and is also made inaccessible to children. Licensee stated that there are no firearms or bodies of water on the premises.

LPA observed children's roster and fire drill log, which was last conducted in Sept 2022. Licensee has current CPR/First aid, which expires August 2023. Licensee’s Mandated Reporter Training expires March 2025. Licensee understands both trainings must be completed every two years. LPA reviewed records of children’s files, all which contained the required documentation.

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SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE: DATE: 03/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/30/2023
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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: KERSEY, CINDY
FACILITY NUMBER: 093605882
VISIT DATE: 03/30/2023
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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing 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)/ (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

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Licensee is aware of and/or practicing safe sleep regulations (102425 Infant Safe Sleep). Licensee stated she does not currently provide care for infants.

No deficiencies were cited during today’s inspection.

Exit interview conducted and report was reviewed with the Licensee. A notice of site visit was provided and must remain posted for 30 days

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023
LIC809 (FAS) - (06/04)
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