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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340300156
Report Date: 02/06/2025
Date Signed: 02/06/2025 03:51:04 PM

Document Has Been Signed on 02/06/2025 03:51 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:CORDOVA BAPTIST PRESCHOOLFACILITY NUMBER:
340300156
ADMINISTRATOR/
DIRECTOR:		HUPPERT, CARRIEFACILITY TYPE:
850
ADDRESS:10527 COLOMA ROADTELEPHONE:
(916) 638-5506
CITY:RANCHO CORDOVASTATE: CAZIP CODE:
95670
CAPACITY: 87TOTAL ENROLLED CHILDREN: 87CENSUS: 16DATE:
02/06/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:TIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Erwina Pascual-Golamco and Regional Manager (RM) Natalie Dunaway, met with Facility Representative (FR), Carrie Huppert, for an unannounced technical support, case management visit. All individuals subject to criminal background review have obtained a criminal record clearance. The purpose of the visit was explained. Facility hours of operation are Monday - Friday, from 7:00am to 5:30pm.

During today's visit, LPA and RM provided FR Assembly Bill 2866, Chapter 745, Statutes of 2024 and HSC: California Code, HSC 1596.814. LPA and RM observed the fencing appeared to meet Title 22 regulations, and observed a rescue pole with a body hook with a minimum fixed length of 12 feet that was visible from the swimming pool and readily available for immediate use.

In addition, FR will need the following:

* An approved safety pool cover that is manually or power operated and meets the performance standards of ASTM International Standard F1346-23. A licensee shall maintain and make available for inspection, upon request by the department, documentation that establishes the cover is compliant with ASTM International Standard F1346-23. OR *An alarm that, when placed in a swimming pool, will sound upon detecting an entrance into the water. The alarm shall be turned on and be in working condition during a facility’s operating hours while the swimming pool is not in use. A licensee shall maintain and make available for inspection, upon request by the department, documentation that establishes the alarm is compliant with ASTM International Standard F2208.



continued on LIC809-C...







SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2025
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: CORDOVA BAPTIST PRESCHOOL
FACILITY NUMBER: 340300156
VISIT DATE: 02/06/2025
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*A life ring with a minimum exterior diameter of 17 inches and labeled as approved by the United States Coast Guard.

*FR shall perform a daily inspection of the drowning prevention safety features and safety equipment before opening the facility and maintain a log of the inspections to be provided to the department upon request. FR will be in contact with LPA and will have the requirements 30 days from today's visit.

No deficiencies cited during today's visit. Exit interview conducted and report was reviewed with FR, Carrie Huppert. 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: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025
LIC809 (FAS) - (06/04)
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