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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093616215
Report Date: 11/18/2021
Date Signed: 11/18/2021 02:55:43 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:COUNTRY KIDS DAYCARE & PRESCHOOLFACILITY NUMBER:
093616215
ADMINISTRATOR:SPRINGER, ASHLEEFACILITY TYPE:
850
ADDRESS:610 PLEASANT VALLEY ROADTELEPHONE:
(530) 642-1630
CITY:DIAMOND SPRINGSSTATE: CAZIP CODE:
95619
CAPACITY:28CENSUS: 17DATE:
11/18/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Ashlee SpringerTIME COMPLETED:
03:00 PM
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On 11/18/2021, Licensing Program Analyst (LPA) Jeremey McClain met with Director Ashlee Springer for an unannounced annual random inspection. LPA observed 17 preschool children supervised by two staff members.

LPA toured all activity and classroom spaces, restrooms, food service, and outdoor play areas. No children in care currently require medications. Facility has central location for storing medications if needed. 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. The areas around or under climbing equipment are cushioned with bark to absorb the fall. Toileting facilities are in safe, sanitary and operating condition. The floors appeared clean throughout the facility. The food preparation space is free of litter and all food was protected against contamination. Storage containers with solid waste have tight-fitting covers. Program provides morning snacks, and lunch and afternoon snacks are provided by children’s families. Menus were posted and drinking water was readily available to children both indoors and outdoors. LPA observed full legal signatures while reviewing the sign in and sign out sheet.

Staff and children's records were reviewed. Each child's file contained an emergency card and a medical assessment. At least one staff member present today has current Pediatric CPR and First Aid certification which expires 10/16/2023. All staff currently employed with the facility have: a criminal record clearance, a health screening report AB1207 Mandated Reporter Training, and documentation of their educational background, training, and/or experience. LPA observed a functional carbon monoxide detector.

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. Report Continued on the following page...

SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Jeremey McClainTELEPHONE: (916) 216-7801
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021
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: COUNTRY KIDS DAYCARE & PRESCHOOL
FACILITY NUMBER: 093616215
VISIT DATE: 11/18/2021
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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 reminded the Director that the Mandated Reporter Training must be completed by all staff once every two years, and that the training can be found at: http://childcare.mandatedreporterca.com/



LPA informed the Director/Licensee/Site Supervisor about Assembly Bill 2370, which will require licensed Child Care Facilities to test their water for excessive amounts of lead. Testing will be required beginning January 1, 2020.

LPA encouraged the Director was encouraged to the visit the Department's website at WWW.CDSS.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining child care centers. LPA also encouraged the Director to sign up for the Child Care Advocates quarterly newsletter.

This facility evaluation report was reviewed and discussed with the Director. A Notice of Site Visit was provided and should remain posted for a period of 30 days for parental review. In the areas that were evaluated, no deficiencies were observed at the time of the inspection.

SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Jeremey McClainTELEPHONE: (916) 216-7801
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021
LIC809 (FAS) - (06/04)
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