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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 570305772
Report Date: 12/16/2024
Date Signed: 12/16/2024 02:22:44 PM

Document Has Been Signed on 12/16/2024 02:22 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
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:ST. PAUL'S LUTHERAN PRESCHOOLFACILITY NUMBER:
570305772
ADMINISTRATOR/
DIRECTOR:		UPTON, CORRIEFACILITY TYPE:
850
ADDRESS:625 WEST GIBSON ROADTELEPHONE:
(530) 662-1935
CITY:WOODLANDSTATE: CAZIP CODE:
95695
CAPACITY: 46TOTAL ENROLLED CHILDREN: 46CENSUS: DATE:
12/16/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:35 PM
MET WITH:Jill HardinTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Lauren Scott met with Facility Representative, Jill Hardin for the purpose of a case management inspection. Licensee has moved the outdoor activity space to a temporary location located on the premises. Licensee is not making any changes to the licensed capacity. The program operates Monday through Friday from 7:00 a.m. to 5:45 p.m.

OUTDOOR ACTIVITY SPACE:
There is one outdoor area on the property. The outdoor play area is fenced with a temporary, safety fencing that is at least four feet tall. LPA observed a sufficient amount of equipment and toys. There is no play structure. There are no bodies of water on the premises. There are shaded areas supplied by trees. Facility Representative stated the permanent outdoor play yard will be getting remodeled. It has an anticipated completion date of early January 2025. Facility Representative will update LPA once completed.

LPA measured the outdoor activity space. The outdoor play area contains a total of 3,600 square feet, which will accommodate the licensed capacity of the facility. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

LR was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Report continues on LIC809-C.
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Lauren Scott
LICENSING EVALUATOR SIGNATURE: DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2024
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
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: ST. PAUL'S LUTHERAN PRESCHOOL
FACILITY NUMBER: 570305772
VISIT DATE: 12/16/2024
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Facility Representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Facility Representative, Jill Hardin.

Effective today, 12/16/2024, LPA will approve the temporary outdoor activity space.
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Lauren Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024
LIC809 (FAS) - (06/04)
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