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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313611140
Report Date: 10/17/2024
Date Signed: 10/17/2024 12:04:58 PM

Document Has Been Signed on 10/17/2024 12:04 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:KIDS PARKFACILITY NUMBER:
313611140
ADMINISTRATOR/
DIRECTOR:		GIGI HARVELFACILITY TYPE:
850
ADDRESS:6801 FIVE STAR BOULEVARDTELEPHONE:
(916) 624-2344
CITY:ROCKLINSTATE: CAZIP CODE:
95677
CAPACITY: 15TOTAL ENROLLED CHILDREN: 15CENSUS: 9DATE:
10/17/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:40 AM
MET WITH:Gigi HarvelTIME VISIT/
INSPECTION COMPLETED:
12:15 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
On Thursday, October 17, 2024, Licensing Program Analysts (LPAs) Lea Habtom and Tanya Washington met with designated representative Alyssa Bair for the purpose of an unannounced 1 year required inspection. During the inspection, Gigi Harvel, arrived and assisted LPAs with the inspection. The facility is a drop in center. Hours of operation is Mon-Thur 8 am- 8pm, Fri 8 am- 10 pm, Sat 10 am- 10 pm and Sun 11 am- 6 pm. The facility offers lunch, dinner & 3 snacks. Upon arrival there were 8 preschool children present and 1 school age child. There were three staff present and the director. The facility has a waiver for a fluctuating capacity based on how many school age children are in care at the time. LPAs toured the facility.

A health and safety inspection were conducted in the classrooms, restrooms, and food service areas. LPA observed the following documents are posted: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, menus, and daily schedule. Cleaning disinfectants and hazardous items are appropriately stored and inaccessible to children. Medications are stored, inaccessible to children. Furniture and equipment are in good condition, and toileting facilities are in sanitary, and operating condition. Bins for solid waste in the kitchen have tight fitting lids. The floors appeared clean throughout the facility. Children bring their own labeled water bottles and filtered water is readily available from refrigerator door. LPAs observed a functional carbon monoxide detector.

LPAs reviewed staff files. LPAs observed all staff with current CPR and First Aid certification. LPAs observed immunization records and documentation of the educational background, training, and/or experience. LPA advised AB1207 Mandated Reporter training must be renewed every two years and can be renewed at www.mandatedreporterca.com.



(Report continues LIC809-C)
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE: DATE: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2024
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 2
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: KIDS PARK
FACILITY NUMBER: 313611140
VISIT DATE: 10/17/2024
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
Children's records were reviewed and were complete.

Facility representative was reminded that all adults 18 and over, 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 Child Care Center. 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual-Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/(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.html



No Title 22 regulations were cited during today's inspection. Exit interview conducted and report was reviewed with the facility representative Gigi Harvel. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2