093610277-1-13-2020-03-CC-MPAL-BKSTTZ-20200113140135

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 093610277
Report Date: 01/13/2020
Date Signed: 01/13/2020 02:01:41 PM

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:	GHS ACADEMY-JR. KINDERGARTEN		FACILITY NUMBER:	093610277
ADMINISTRATOR:	PERRY, TAMARA		FACILITY TYPE:	850
ADDRESS:	1060 SUNCAST LANE		TELEPHONE:	(916) 933-0100
CITY:	EL DORADO HILLS	STATE: CA	ZIP CODE:	95762
CAPACITY:	22	CENSUS: 13	DATE:	01/13/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:20 PM
MET WITH:			TIME COMPLETED:	02:15 PM

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Licensing Program Analyst (LPA) Michelle Pascual and Licensing Program Manager (LPM) Bettina Engleman met with Tamara Perry, Director, for the purpose of an unannounced annual random visit. Thirteen(13) pre-school children were present upon arrival. The facility operates in Jr. Kindergarten Room on the campus of Golden Hills School. It conducts all day preschool Monday-Friday 7:00 AM - 3:00 pm.

LPA toured the facility inside and out for a health and safety inspection. PHYSICAL PLANT-The facility appeared orderly and suitable for children. All cleaning supplies and hazardous items are stored inaccessible to children. Medications are stored in a safe place inaccessible to children in care. Outdoor activity space and equipment was in good repair. Areas around high climbing equipment had cushioning materials. Storage containers for solid waste had lids. The program doesn’t offer snacks or lunch; however, each child is required to bring their snack, lunch and drink. Uncontaminated drinking water is available both indoors and outside. FACILITY ADMINISTRATION- All staff present today had criminal background check clearances and facility associations. Current CPR was noted with an expiration date of 06/21.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Michelle Pascual	TELEPHONE: (916) 704-7665
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2020

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: GHS ACADEMY-JR. KINDERGARTEN	FACILITY NUMBER: 093610277
	VISIT DATE: 01/13/2020

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This facility provides Incidental Medical Services – IMS. LPA reviewed storage 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

EVALUATION OF CARE AND SUPERVISION- Visual supervision was observed during the visit. Capacity and ratio requirements were being met. FACILITY RECORDS REVIEW- Children’s records included admission agreements. Facility maintained Sign In/Out Sheets. Staff records included documentation of the educational background, training, and/or experience and immunization records.

Based on today's visit no title 22 deficiencies were observed.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Michelle Pascual	TELEPHONE: (916) 704-7665
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2020

LIC809 (FAS) - (06/04)

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