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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343614029
Report Date: 07/21/2023
Date Signed: 07/21/2023 12:30:07 PM

Document Has Been Signed on 07/21/2023 12:30 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:SMALLVILLE PRESCHOOLFACILITY NUMBER:
343614029
ADMINISTRATOR:NULL SHANNONFACILITY TYPE:
850
ADDRESS:4706 ARDEN WAYTELEPHONE:
(916) 480-0632
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 26DATE:
07/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Shannon NullTIME COMPLETED:
12:45 PM
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On July 21, 2023 at approximately 9:55 AM, Licensing Program Analyst (LPA) Josiah Gathing met with Licensee Shannon Null for the purpose of an unannounced annual random inspection. LPA observed care and supervision of 26 preschool children by 5 staff and the Licensee. The facility has a maximum capacity of 72. The facility hours of operation are Monday through Friday from 7:00 AM to 6:00 PM.

LPA toured the classrooms, restrooms, kitchen, office, and outdoor play areas. Licensee stated there are no firearms on the premises. 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 and the ground below the play structure is sufficiently padded. Restrooms are in sanitary condition with functioning toilets. The floors were clean throughout the facility. Medications are stored in a high cabinet, out of children’s reach and labeled according to regulation.

LPA observed that solid waste containers were covered. Per Licensee, the facility provides snacks and parents provide meals daily. Drinking water was readily available to children both indoors and outdoors. LPA observed a sign in and out sheet which showed all children present with parent’s full signatures.

All present staff files were reviewed and found to be complete. LPA observed current Mandated Reporter certificate which will expire May 11, 2024 and current CPR and First Aid certificate which will expire February 28, 2025.

LPA observed the sample of children’s files contained the appropriate documents. LPA observed complete children’s roster on file and a current fire drill log last updated July 14, 2023. LPA observed first aid equipment, functioning smoke and carbon monoxide detectors, pull alarms, and fully charged fire extinguishers meeting regulation. Required documents were posted.

Report continues on LIC809-C…

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Josiah Gathing
LICENSING EVALUATOR SIGNATURE: DATE: 07/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/21/2023
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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: SMALLVILLE PRESCHOOL
FACILITY NUMBER: 343614029
VISIT DATE: 07/21/2023
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LPA discussed Incidental Medical Services – IMS. 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

Licensee was encouraged to the visit the Department's website at WWW.CCLD.CA.GOV for information regarding child care updates, PINs, forms, regulations and legislation pertaining to child care centers.

No deficiencies were cited based on today’s inspection. Exit interview was conducted and report was reviewed with the Licensee. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Josiah Gathing
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2023
LIC809 (FAS) - (06/04)
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