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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623051
Report Date: 03/20/2023
Date Signed: 03/20/2023 01:36:43 PM

Document Has Been Signed on 03/20/2023 01:36 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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:KIDS PARK-FOLSOM(PS)FACILITY NUMBER:
343623051
ADMINISTRATOR:AMIRI, AZADEHFACILITY TYPE:
850
ADDRESS:1111 RILEY STREETTELEPHONE:
(916) 293-8786
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 12DATE:
03/20/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Administrator Ladan Shojaei KavanTIME COMPLETED:
01:45 PM
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Licensing Program Analyst Jennifer Velasco (LPA) conducted an unannounced case management inspection and met with facility representative, Administrator Ladan Shojael Kavan (M1). LPA toured the facility, including all activity and classroom spaces, restrooms, food service and outdoor play areas. Upon arrival, LPA observed 12 children in care being supervised by two classroom staff. D1 was reminded never to exceed the conditions, limitations, and capacity specified the license. Facility hours of operation are Monday through Friday 7:30 AM - 8:00 PM, Saturday 9:00 AM - 9:00 PM, and Sunday 11:00 AM - 6:00 PM.

The purpose of today's case management inspection is to verify the facility is operating within the limitations of the license; specifically, enrolling children for no more than twenty hours per week per child and no more than ten hours per day per child. The facility had a waiver to enroll children full-time for the duration of the Covid 19 Governor's Public Health Emergency Orders, which ended 02/28/2023. LPA notified M1 of the end of the waiver prior to 02/28/2023.

During today's inspection, LPA conducted witness interviews, reviewed facility documents, and observed staff providing care to children. Witness statements and facility documentation provided evidence that the facility is operating within the terms and conditions of the license by only enrolling children for a total of no more than twenty hours per week per child and no more than ten hours per day per child.

No deficiencies were cited during today's inspection. An exit interview was conducted and a notice of site visit was provided and must be posted where visible to parents for 30 days.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Jennifer Velasco
LICENSING EVALUATOR SIGNATURE: DATE: 03/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/20/2023
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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