343614029-7-13-2022-03-CC-KGUA-CGAQKT-20220713121454

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343614029
Report Date: 07/13/2022
Date Signed: 07/13/2022 12:15:00 PM

Document Has Been Signed on 07/13/2022 12:15 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME:	SMALLVILLE PRESCHOOL		FACILITY NUMBER:	343614029
ADMINISTRATOR:	NULL SHANNON		FACILITY TYPE:	850
ADDRESS:	4706 ARDEN WAY		TELEPHONE:	(916) 480-0632
CITY:	CARMICHAEL	STATE: CA	ZIP CODE:	95608
CAPACITY: 30	TOTAL ENROLLED CHILDREN: 30	CENSUS: 19	DATE:	07/13/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Shannon Null		TIME COMPLETED:	12:20 PM

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At 9:50 a.m. on Wednesday, July 13th, 2022, Licensing Program Analyst (LPA) Karyn Guerra met with Licensee, Shannon Null, for the purpose of an unannounced Required - 1 Year inspection. Census at time of arrival was 19 children supervised by 3 staff. A risk assessment for COVID-19 was conducted. Hours of operation are 7:00 a.m. - 6:00 p.m., Monday thru Friday.

All individuals subject to criminal background review have obtained criminal record clearance. Director 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.

A health and safety inspection was conducted in the classrooms, restrooms, food service areas, and outdoor play 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. Director stated there are no weapons nor poisons on the premises. Furniture and equipment are in good condition, and toileting facilities are in safe, sanitary, and operating condition. Bins for solid waste in the have tight fitting lids. The floors appeared clean throughout the facility. The facility provides breakfast, and morning/afternoon snacks. The food preparation space is free of litter and all food was protected against contamination. Drinking water was readily available to children both indoors and outdoors via drinking fountains and filtered water in labeled bottles. LPA observed full legal signatures of authorized representatives in sign in/sign out logs. There are no bodies of water on the premises. Disaster drills have been conducted and documented. Playground equipment and surfaces are free of loose or sharp

Report continues on 809-C.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Karyn Guerra
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2022

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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: SMALLVILLE PRESCHOOL	FACILITY NUMBER: 343614029
	VISIT DATE: 07/13/2022

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parts. LPA observed wood chip cushioning beneath the play structure. Outdoor shade is provided by trees.

Staff files were reviewed. At least one staff member present today has current Pediatric CPR and First Aid certification. LPA observed immunization records and documentation of the educational background, training, and/or experience and AB 1207 Mandated Reporter training certificates.

Children's records were reviewed. Each child's file contained an emergency card, consent for emergency medical treatment and notifications of children’s and parent’s rights, health history, physician's report and immunization records.

This facility provides Incidental Medical Services – IMS. LPA will follow up with materials regarding a plan of operation. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s personnel and administrative records. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.

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.

LPA verified the annual fees are current. A staff interview was conducted with the Licensee, Shannon Null. LPA reminded Licensee about written directives for lead testing AB2370, and will follow up with an email containing PINs.

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.

In the areas that were evaluated, no deficiencies were cited during today’s inspection. Exit interview conducted and report was reviewed with Licensee, Shannon Null. A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Karyn Guerra
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2022

LIC809 (FAS) - (06/04)

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