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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623052
Report Date: 10/21/2021
Date Signed: 10/21/2021 12:35:49 PM

Document Has Been Signed on 10/21/2021 12:35 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:KIDS PARK-FOLSOM(SA)FACILITY NUMBER:
343623052
ADMINISTRATOR:NASLUND, JULIAFACILITY TYPE:
840
ADDRESS:1111 RILEY STREETTELEPHONE:
(916) 293-8786
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 16DATE:
10/21/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Ladan KavanTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Kelly Ferrara met with Facility Representative Ladan Kavan for an unannounced annual inspection on October 21st. At 10:45 AM, LPA toured the facility including all activity and classroom spaces, restrooms, food service and play areas. Appropriate ratio and care and supervision were observed during today's inspection. Census included 16 children being supervised by three staff. Facility Representative was reminded never to exceed the conditions, limitations and capacity specified on the license. Facility hours of operation are Monday through Friday from 7:30 AM-8 PM, Saturday 9 AM-9 PM, and Sunday 11 AM- 6 PM.

Facility Representative 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.

The center appeared clean including the carpets and floor. Chemicals were kept inaccessible to children in a storage room. There is an indoor gross motor area for the children to use in place of an outdoor playground (waiver on file). Uncontaminated drinking water was readily available to the children. Bathrooms were clean and all sinks and toilets were in operating condition. There are no firearms or bodies of water on the premises and the facility has at least one functioning smoke and carbon monoxide detector. LPA observed all required licensing documentation was posted for parental review. LPA observed that parents are signing their children in and out of the center. LPA discussed current Covid guidelines with the Facility Representative.

Continued on 809-C

SUPERVISORS NAME: Maria Mayorga
LICENSING EVALUATOR NAME: Kelly Ferrara
LICENSING EVALUATOR SIGNATURE: DATE: 10/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/21/2021
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: KIDS PARK-FOLSOM(SA)
FACILITY NUMBER: 343623052
VISIT DATE: 10/21/2021
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At 11:30 AM, a sample of staff files were reviewed. LPA reviewed staff transcripts and observed all staff were qualified. LPA observed all staff had a current Mandated Reporter certificate and proof of immunizations. At least one staff had a current Pediatric CPR and First Aid certification that expires July 2023. LPA observed all children’s files contained the appropriate documents. LPA observed a current children's roster and a fire/disaster drill log. The facility has First Aid equipment.

This facility provides 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

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/inspection-process.

Facility Representative 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 issued based on today’s inspection. Exit interview was conducted and report was reviewed with the Facility Representative Ladan Kavan. A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Maria Mayorga
LICENSING EVALUATOR NAME: Kelly Ferrara
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021
LIC809 (FAS) - (06/04)
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