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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343616737
Report Date: 10/07/2022
Date Signed: 10/07/2022 03:44:13 PM

Document Has Been Signed on 10/07/2022 03:44 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:CALVARY CHRISTIAN SCHOOL-AGE CAREFACILITY NUMBER:
343616737
ADMINISTRATOR:ARRIAGA, SUSANFACILITY TYPE:
840
ADDRESS:4911 47TH AVENUETELEPHONE:
(916) 393-3633
CITY:SACRAMENTOSTATE: CAZIP CODE:
95824
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 1DATE:
10/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Susan ArriegaTIME COMPLETED:
03:45 PM
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On Friday, October 7, 2022 at 12:00 PM, Licensing Program Analyst (LPA) Amanda Sutter met with Director Susan Arriega for the purpose of an unannounced required annual inspection. There were no children present at LPA’s arrival. At 2:15 PM, LPA observed 1 child supervised by 1 staff. Facility operates in classroom 1. The facility hours of operation are Monday through Thursday from 6:00 AM to 6:00 PM.

LPA toured classroom spaces, restrooms, and outdoor play area. LPA observed the following documents are posted: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, menu, and seat belt law. Cleaning disinfectants, medications and hazardous items are appropriately stored and inaccessible to children. Site Supervisor stated there are no poisons or firearms on the premises. Furniture and equipment are in good condition, and toileting facilities are in safe, sanitary and operating condition. The program provides breakfast, lunch, and an afternoon snack.

LPAs observed trash bins with tight fitted lids. LPA observed the facility’s paper sign in and out system. The facility plans to transition to an electronic sign in and out system Facility has record of conducting fire drills at least every six months. Playground equipment and surfaces are free of loose or sharp parts and astro-turf is present under the equipment to provide sufficient cushioning. There are sufficient equipment and toys, and shaded areas are supplied by shade structures and the building.

One staff record and one children record were reviewed. Both files were observed to be complete There is at least one staff member present with a current CPR certificate. LPA observed a functional carbon monoxide detector, smoke detector and fire extinguisher.

PAGE 1. REPORT CONTINUES ON LIC809-C

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Amanda Sutter
LICENSING EVALUATOR SIGNATURE: DATE: 10/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/07/2022
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: CALVARY CHRISTIAN SCHOOL-AGE CARE
FACILITY NUMBER: 343616737
VISIT DATE: 10/07/2022
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LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPAS also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Service (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.htm

Site Supervisor 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.

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.

During today’s inspection, no citations have been issued. Appeal rights were provided. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Site Supervisor Susan Arriega.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Amanda Sutter
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2022
LIC809 (FAS) - (06/04)
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