343624247-2-6-2023-03-CC-EPGO-CNSSC7-20230206124505

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343624247
Report Date: 02/06/2023
Date Signed: 02/06/2023 12:45:15 PM

Document Has Been Signed on 02/06/2023 12:45 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:	EXCELSIOR PRESCHOOL GOLD RIVER LLC		FACILITY NUMBER:	343624247
ADMINISTRATOR:	FUGATE, NANCY		FACILITY TYPE:	850
ADDRESS:	2317 GOLD MEADOW WAY		TELEPHONE:	(916) 730-8757
CITY:	GOLD RIVER	STATE: CA	ZIP CODE:	95670
CAPACITY: 118	TOTAL ENROLLED CHILDREN: 118	CENSUS: 23	DATE:	02/06/2023
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Nancy Fugate		TIME COMPLETED:	01:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Manger Natalie Dunaway and Licensing Program Analyst (LPA) Erwina Pascual-Golamco met with Director Nancy Fugate for an unannounced annual inspection on Monday, 2/6/202. At about 9:30 AM, LPM an LPA toured the facility including all activity and classroom spaces, restrooms, food service and outdoor play areas. Director was reminded never to exceed the conditions, limitations and capacity specified on the license. Facility hours of operation are Monday through Friday 7 AM to 6 PM. 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. Classrooms all appeared clean including the carpets and floor. Chemicals and cleaning materials were kept inaccessible to children. Playground equipment and surfaces were inspected and are in good condition with enough resilient material under climbing structures to absorb a fall. Uncontaminated drinking water was readily available to children both indoors and outdoors. Bathrooms were clean and all sinks and toilets were in operating condition. There are no firearms or bodies of water on the premises. Menus were posted for AM and PM snack and the lunch is provided. Staff files were reviewed. LPM and LPA reviewed staff transcripts and observed all staff being utilized as teachers 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 12/17/23. LPM and LPM and LPA observed the sample of children’s files contained the appropriate documents. LPM and LPA observed a current children's roster and a disaster drill log. The facility is equipped with First Aid equipment.

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE:	DATE: 02/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2023

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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: EXCELSIOR PRESCHOOL GOLD RIVER LLC	FACILITY NUMBER: 343624247
	VISIT DATE: 02/06/2023

NARRATIVE

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This facility provides Incidental Medical Services – IMS. LPM and 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 cited based on today’s inspection. Exit interview was conducted and report was reviewed with the Facility Representative. A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE:	DATE: 02/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2023

LIC809 (FAS) - (06/04)

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