093610853-12-9-2019-03-CC-ESIA-BJPR6W-20191209114524

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 093610853
Report Date: 12/09/2019
Date Signed: 12/09/2019 11:45:36 AM

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:	GOLD OAK PRESCHOOL		FACILITY NUMBER:	093610853
ADMINISTRATOR:	MILLER/CUTRIGHT		FACILITY TYPE:	850
ADDRESS:	3171 PLEASANT VALLEY RD		TELEPHONE:	(530) 622-9331
CITY:	PLACERVILLE	STATE: CA	ZIP CODE:	95667
CAPACITY:	22	CENSUS: 13	DATE:	12/09/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Kthy Miller		TIME COMPLETED:	11:45 AM

NARRATIVE

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Licensing Program Analyst (LPA) Elvira Sierra met with Designee, Kathrine L. Miller for the purpose of an unannounced annual random inspection. Census included 13 preschool children supervised by 3 staff members. Facility operates from M-F, during school calendar: 08:00 AM to 2:30PM. Programs operates inside the Gold Oak Elementary School grounds.

LPA toured all activity and classroom spaces, restrooms, food service, and outdoor play areas. Medications are appropriately stored and inaccessible to children. Designee stated there are no poisons on the premises. Toxic and hazardous items are inaccessible to children. Furniture and equipment are in good condition. Playground equipment and surfaces are free of loose or sharp parts. Toileting facilities are in safe, sanitary and operating condition. The floors appeared clean throughout the facility. Storage containers with solid waste have tight-fitting covers. Program provides meals that are prepared at the main kitchen at EDCOE (El Dorado County of Education). Menus were posted and drinking water was readily available to children both indoors and outdoors.

There are no firearms or bodies of water on the premises. LPA observed a functional carbon monoxide detector. LPA reviewed the Department's inspection authority and discussed with Designee any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within ten working days. LPA reminded Designee that 100% supervision is required at all times, including in the bathroom.

Staff and children's records were reviewed. All staff currently employed with the facility have been fingerprinted through EDCOE. Health screening report, and documentation of the educational background, training, and/or experience is on file. All staff present today have current Pediatric CPR and First Aid certification. LPA observed child’s admission agreement on children’s files. Full legal signatures and time was observed in sign in/out sheets.

Report continued on subsequent page 809C-----------

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira Sierra	TELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2019

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: GOLD OAK PRESCHOOL	FACILITY NUMBER: 093610853
	VISIT DATE: 12/09/2019

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Facility is currently providing Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated 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 reviewed AB 1207- Mandated Reporter Training was review. Staff must complete the training every two years starting January 1, 2018 and retain proof of completion in the facility file. The training can be could at: mandatedreporterca.com. LPA observed all staff have completed the training.Safe Sleep in Child Care, Effects of Lead exposure and Quarterly Update Summer 2019 publications were provided to Designee.

Designee was updated on new immunization requirements from the Department of Public Health(CDHP) that will become effective July 1, 2019. Additional information and resources can be found on the https://www.shotsforschool.org website.

LPA verified the annual fees are current.

This facility evaluation report was reviewed and discussed with Designee. A Notice of Site Visit was provided and should remain posted for a period of 30 days for parental review. LPA provided the Child Care Advocates Program email address: childcareadvocatesprogram@dss.ca.gov, so Designee can request to be added to the distribution list to receive Quarterly Updates. Designee was encouraged to the visit the department's website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining child care centers. In the areas that were evaluated, no deficiencies were observed at the time of the visit.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira Sierra	TELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:	DATE: 12/09/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2019

LIC809 (FAS) - (06/04)

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