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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624613
Report Date: 11/22/2022
Date Signed: 11/22/2022 10:55:34 AM

Document Has Been Signed on 11/22/2022 10:55 AM - 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:EXCELSIOR PRESCHOOL GOLD RIVER LLCFACILITY NUMBER:
343624613
ADMINISTRATOR:FUGATE, NANCYFACILITY TYPE:
830
ADDRESS:2317 GOLD RIVER WAYTELEPHONE:
(916) 775-8618
CITY:GOLD RIVERSTATE: CAZIP CODE:
95670
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 0DATE:
11/22/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Nancy FugateTIME COMPLETED:
11:15 AM
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Application Specialist (AS) Mai Lor, and Licensing Program Analyst (LPA) Soleil Marx met with Applicant Nancy Fugate for the purpose of an announced pre-licensing inspection. Applicant is requesting an infant license to serve 24 infant children from birth to 24 months. The program will operate Monday through Friday from 7:00 AM to 6:00 PM. The fire clearance was granted on 11/14/2022.

AS reviewed with applicant the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted. Applicant acknowledges that the following documents must be posted at all times: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, Effects of Lead Exposure, car seat poster, menus, and daily schedule.

Applicant stated the Needs and Services plans will be kept in the classrooms. The facility will be providing breakfast, lunch, and snacks to infants transitioning over to solid food. Parents will provide formula, breast milk, and baby food for their children.

INDOOR ACTIVITY SPACE:
There are two infant classrooms: Infant and Toddler. The classrooms are equipped with sufficient infant size furnishing, cubbies and a variety of age-appropriate toys that appear to be in good repair. AS and LPA observed 12 cribs in the napping room. Applicant acknowledges there will be a maximum of 12 infants under 12 months old, due to available cribs. There is a kitchen to support the food service equipped with a stove and refrigerator. The napping area is physically separated from the activity space. AS observed the classrooms to be clean, safe, sanitary and in good repair. AS observed containers used for storage of solid wastes, including moveable bins, to have a tight fitting cover that is kept on and in good repair.

(Report continued on subsequent LIC 809)
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Mai Lor
LICENSING EVALUATOR SIGNATURE: DATE: 11/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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: EXCELSIOR PRESCHOOL GOLD RIVER LLC
FACILITY NUMBER: 343624613
VISIT DATE: 11/22/2022
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There is a first aid kit in the office. Medication will be stored at the front desk in a locked box and inaccessible to children in care. AS and LPA observed cleaning disinfectants appropriately stored and inaccessible to children. Applicant stated there are no firearms or weapon on the premises. Applicant stated indoor and outdoor drinking water will be provided via water pitchers with individualized water bottles. AS and LPA observed carbon monoxide detector in the facility. AS and LPA observed paper sign-in/sign-out system.

AS and LPA measured the classrooms. The total classroom space contains a total of 1026.797 square feet, which will accommodate Applicant's requested capacity for 24 infant children. There are four sinks available in the classrooms. AS did not observed potty chairs in the classrooms. The applicant was reminded that there shall be one potty chair to every five infants being toilet trained. Toilets and sinks for hand washing are in closed proximity to indoor and outdoor space. AS and LPA observed one changing table with a changing pad that is at least one inch think with raised sides that are at least three inches tall and within arm’s reach of a sink in each of the classrooms. Children who become ill during the day will be isolated in the office area and will use the staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:
There is one outdoor area on the property designated for infants and is separate from the preschool outdoor activity space. The outdoor play area is surrounded by a fence that is at least four feet tall. AS and LPA observed a variety of age-appropriate outdoor toys and equipment. The playground is shaded by shade canopy and overhangs.

AS and LPA measured the outdoor activity space. The outdoor play area contains a total of 4380.83 square feet, which will accommodate the applicant's requested capacity of 24 infants.

AS discussed the following: 100% supervision is required at all times; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. AS discussed with Applicant any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

(Report continued on subsequent LIC 809)

SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Mai Lor
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: EXCELSIOR PRESCHOOL GOLD RIVER LLC
FACILITY NUMBER: 343624613
VISIT DATE: 11/22/2022
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This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A 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.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA 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.

Applicant 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.



Licensee was encouraged to visit the Department website at WWW.CCLD.CA.GOV for child care updates, current forms, legislation and regulation information. A copy of this report will remain on file for a period of three years for public review upon request.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

The following items are required before a license will be issued:

1. Pending Licensing Program Manager’s final review

Exit interview conducted and report was reviewed with Applicant, Nancy Fugate.

SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Mai Lor
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2022
LIC809 (FAS) - (06/04)
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