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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313602542
Report Date: 06/17/2021
Date Signed: 06/17/2021 09:16:44 AM

Document Has Been Signed on 06/17/2021 09:16 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:STAR MAIDUFACILITY NUMBER:
313602542
ADMINISTRATOR:BARKER, JODIFACILITY TYPE:
840
ADDRESS:1950 JOHNSON RANCH ROADTELEPHONE:
(916) 782-8454
CITY:ROSEVILLESTATE: CAZIP CODE:
95661
CAPACITY: 300TOTAL ENROLLED CHILDREN: 0CENSUS: 45DATE:
06/17/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Jodi BarkerTIME COMPLETED:
09:15 AM
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On June 17th, 2021 at 8:15 am, Licensing Program Analyst (LPA) Jeremey McClain met with director Jodi Barker for the purpose of an unannounced annual random inspection. Today’s census was 45 school age children, supervised by eight staff members

LPA toured the all classroom spaces, restrooms, and outdoor play areas. Medications are appropriately stored and inaccessible to children. Toxic and hazardous items are inaccessible to children. Furniture and equipment are in good condition. Playground equipment and surfaces are free of loose or sharp parts. Toileting facilities are in safe, sanitary and operating condition. The floors appeared clean throughout the facility. Currently, families provide children with their own meals for breakfast, lunch and snack. LPA observed full legal signatures while reviewing the sign in and sign out sheet as required for school age component.



Staff and children's records were reviewed. Each child's file contained an emergency card. At least one staff member present today has current Pediatric CPR and First Aid certification (exp. 09/2021). All staff currently employed with the facility has a criminal record clearance, health screening report, Mandated Reporter training certificates, and documentation of the educational background, training, and/or experience. There are no firearms or bodies of water on the premises.

This facility evaluation report was reviewed and discussed with Director.

A Notice of Site Visit was provided and should remain posted for a period of 30 days for parental review.

Director was encouraged to the visit the department's website at WWW.CDSS.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining child care centers.

In the areas that were evaluated, no deficiencies were observed.

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Jeremey McClain
LICENSING EVALUATOR SIGNATURE: DATE: 06/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/17/2021
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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