090306363-9-12-2024-03-CC-SMAX-D92R4F-20240912124129

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 090306363
Report Date: 09/12/2024
Date Signed: 09/12/2024 12:41:33 PM

Document Has Been Signed on 09/12/2024 12:41 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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	PLACERVILLE HEAD START-STATE PRESCHOOL		FACILITY NUMBER:	090306363
ADMINISTRATOR:	SMITH/BANGS/DRAKE		FACILITY TYPE:	850
ADDRESS:	2870 SCHNELL SCHOOL ROAD		TELEPHONE:	(530) 295-4502
CITY:	PLACERVILLE	STATE: CA	ZIP CODE:	95667
CAPACITY:	53	CENSUS: 24	DATE:	09/12/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:05 AM
MET WITH:	Lisa Smith		TIME COMPLETED:	12:50 PM

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On September 12, 2024, Licensing Program Analyst (LPA) Soleil Marx, met with Facility Representative, Lisa Smith, for an unannounced annual inspection. LPA observed a census 24 preschool age children being supervised by five staff in two separate classrooms. Facility Representative was reminded never to exceed the conditions, limitations and capacity specified on the license. All individuals subject to criminal background review have obtained a criminal record clearance. Facility hours of operation are Monday through Friday, 08:30 AM to 03:00 PM.

LPA inspected all activity and classroom spaces, restrooms, food service, and outdoor play areas. Hazardous items were inaccessible to children. The floors appeared clean throughout the facility. Furniture and equipment were in safe, operable condition. Outdoor activity space and equipment were in good repair and free of loose or sharp parts. LPA observed adequate cushioning in areas underneath climbing equipment and adequate shade provided. Toileting facilities were in safe, sanitary, and operating condition. Food preparation space was hygienic, and all food protected against contamination. Menus were posted for AM/PM snack and lunch, which is provided by the facility. Uncontaminated drinking water was readily available to children both indoors and outdoors. Trash bins have tight-fitting lids. LPA observed medications were stored in a central location and an ample amount of first aid supplies available. LPA observed a functional carbon monoxide detector, smoke detector, and fully charged 2A10BC fire extinguisher within the facility. LPA observed authorized representatives are using full legal signatures on the sign in and out sheet. There are no bodies of water on the premises.

LPA reviewed facility records including child's records, personnel records, administrative records, and documents to be posted. LPA reviewed a sample of children’s files and observed that each child's file contained the required licensing documentation. LPA reviewed records for staff. At least one staff member present today has current Pediatric CPR and First Aid certification expiring 01/2025. All staff currently employed with the facility have: a criminal record clearance, a health screening report, immunization records, current AB1207 Mandated Reporter Training, and documentation of their educational background, training, and/or experience. LPA observed a children's roster and fire drill log within the facility. LPA observed all required licensing documents were posted and visible to authorized representatives.

SUPERVISOR'S NAME: Natalie Dunaway	TELEPHONE: (916) 584-3508
LICENSING EVALUATOR NAME: Soleil Marx	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024

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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: PLACERVILLE HEAD START-STATE PRESCHOOL	FACILITY NUMBER: 090306363
	VISIT DATE: 09/12/2024

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Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP

CCC COMPLETED TESTING AND NO LEAD EXCEEDANCES

LPA referred facility representative to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

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 PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/.

Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

No Title 22 deficiencies were cited based on today's inspection.

Exit interview conducted and report was reviewed with the Facility Representative, Lisa Smith. A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Natalie Dunaway	TELEPHONE: (916) 584-3508
LICENSING EVALUATOR NAME: Soleil Marx	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024

LIC809 (FAS) - (06/04)

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