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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093616919
Report Date: 01/08/2020
Date Signed: 01/08/2020 11:58:02 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:MARBLE VALLEY PRESCHOOLFACILITY NUMBER:
093616919
ADMINISTRATOR:ANGELA MASTERSONFACILITY TYPE:
850
ADDRESS:5005 HILLSDALE CIRCLETELEPHONE:
(916) 933-5122
CITY:EL DORADO HILLSSTATE: CAZIP CODE:
95762
CAPACITY:15CENSUS: 12DATE:
01/08/2020
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:TIME COMPLETED:
12:30 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
Licensing Program Analyst (LPA) Michelle Pascual and Licensing Program Manager (LPM) Bettina Engleman met with Director Angela Masterson for the purpose of an unannounced required three- year visit. Eight (12) preschool children were present upon arrival. The facility conducts two part time programs and is open 8:30 a.m. to 3:00 p.m.

LPA’s toured the facility inside and out for a health and safety inspection. PHYSICAL PLANT-The facility appeared orderly and suitable for children. Cleaning supplies and hazardous items were 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; each child is required to bring their own snack and water. Uncontaminated drinking water is available both indoors and outside. The facility has a working smoke detector and has one or more functioning carbon monoxide detector that meets statutory requirements. LPA observed a current fire drill log. Facility has license posted, parents rights, emergency evacuation and car seat safety. FACILITY ADMINISTRATION-All staff present today had a criminal background check clearance. LPA reviewed storage of 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

SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Michelle PascualTELEPHONE: (916) 704-7665
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2020
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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: MARBLE VALLEY PRESCHOOL
FACILITY NUMBER: 093616919
VISIT DATE: 01/08/2020
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
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 a current CPR/First Aide expires 01/2020, and documentation of the educational background, training, and/or experience.

LPA discussed mandatory reporter training, as well as SB 277 and SB 792 pertaining to immunization requirements for children and staff. LPA advised the site supervisor to visit the licensing website at www.ccld.ca.gov for current forms, laws, regulations and legislation. A Notice of Site Visit was posted and must remain posted for a period of 30 days and appeal rights provided.

Based upon today’s evaluation and observation, there were no title 22 deficiencies.

SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Michelle PascualTELEPHONE: (916) 704-7665
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2020
LIC809 (FAS) - (06/04)
Page: 2 of 2