<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093610853
Report Date: 05/05/2023
Date Signed: 05/05/2023 02:05:34 PM


Document Has Been Signed on 05/05/2023 02:05 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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833



FACILITY NAME:GOLD OAK PRESCHOOLFACILITY NUMBER:
093610853
ADMINISTRATOR:MILLER, KATHRINE LFACILITY TYPE:
850
ADDRESS:3171 PLEASANT VALLEY RDTELEPHONE:
(530) 622-9331
CITY:PLACERVILLESTATE: CAZIP CODE:
95667
CAPACITY:22CENSUS: 10DATE:
05/05/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Kathrine MillerTIME COMPLETED:
02:20 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On May 5th, 2023, Licensing Program Analyst (LPA) Soleil Marx met with Facility Representative, Kathrine Miller, for an unannounced required annual inspection. LPA observed a census of 10 preschool age children being supervised by three staff. Facility Representative was reminded never to exceed the conditions, limitations and capacity specified on the license. Hours of operation are Monday through Friday 08:00 AM to 2:30PM.

LPA inspected all activity and classroom spaces, restrooms, food service, and outdoor play areas. Hazardous items are inaccessible to children. The floors appeared clean throughout the facility. Furniture and equipment are in safe, operable condition. LPA observed a variety of age-appropriate toys available to children within the facility. Playground equipment is 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 are in safe, sanitary, and operating condition. The food preparation space is free of litter and all food protected against contamination. Menus were posted for AM/PM snack and lunch, which is provided by the facility. Uncontaminated drinking water is readily available to children both indoors and outdoors. Storage containers with solid waste have tight-fitting covers in each classroom. Medications are stored in a high cabinet inside a lock box, inaccessible to children in care. LPA observed a functional carbon monoxide detector within the facility. LPA observed parents use full legal signatures on the sign in and out sheet. LPA observed required postings, children’s roster, and a fire/disaster drill log in which the last drill was conducted on 04/28/2023.

LPA reviewed records for all present staff. At least one staff member present today has current Pediatric CPR and First Aid certification expiring 06/2023. All staff currently employed with the facility have: a criminal record clearance, a health screening report, immunization records, current Mandated Reporter Training, and documentation of their educational background, training, and/or experience. A sample of children’s records were reviewed, LPA observed that each child's file contained all the required documents. (1/2)
SUPERVISOR'S NAME: Natalie DunawayTELEPHONE: (916) 584-3508
LICENSING EVALUATOR NAME: Soleil MarxTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 05/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/05/2023
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 2


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: GOLD OAK PRESCHOOL
FACILITY NUMBER: 093610853
VISIT DATE: 05/05/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA informed Facility Representative about Assembly Bill 2370, which will require certain licensed Child Care Facilities to test their water for excessive amounts of lead. Testing will be required beginning January 1, 2023. Facility has water outlet testing for lead is scheduled for May 2023.

Incidental Medical Services (IMS) policy was discussed. The facility is not currently providing IMS. 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.

Facility Representative was reminded that all adults 18 and older working in the facility, 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 licensed 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.

LPA encouraged the Director was encouraged to the visit the Department's website at WWW.CDSS.CA.GOV for information regarding childcare updates, forms, regulations and legislation pertaining childcare centers. LPA also encouraged the Director to sign up for the Child Care Advocates quarterly newsletter.
To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

No deficiencies were cited during today’s inspection.

This report was reviewed with Facility Representative, and an exit interview was conducted. A Notice of Site Visit was provided and must remain posted for 30 days. (2/2)

SUPERVISOR'S NAME: Natalie DunawayTELEPHONE: (916) 584-3508
LICENSING EVALUATOR NAME: Soleil MarxTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2