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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 293617518
Report Date: 07/08/2019
Date Signed: 07/08/2019 03:06:36 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:KINDERLAND PRESCHOOL INFANT CENTERFACILITY NUMBER:
293617518
ADMINISTRATOR:PETERSON, LUPEFACILITY TYPE:
830
ADDRESS:12815 COLFAX HIGHWAYTELEPHONE:
(530) 273-1255
CITY:GRASS VALLEYSTATE: CAZIP CODE:
95945
CAPACITY:16CENSUS: 8DATE:
07/08/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Lupe Peterson - AdministratorTIME COMPLETED:
01:00 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) Blake Morillas met with the Administrator, Lupe Peterson, for the purpose of an unannounced Annual/Random inspection. Today’s census was 8 infants and 4 staff in separate rooms.
Operating hours are Monday through Thursday from 7:30am to 5:30pm, and Fridays from 7:30am to 4:00pm. The facility operates year around.

LPA observed that hazardous items (disinfectants, cleaning solutions, etc.) were inaccessible to children in care. LPA inspected the food service area and observed that the food products appeared to be protected against contamination. LPA reviewed care and supervision of children, staffing ratios, furniture, equipment, and fire drills logs. Drinking water is readily accessible to children in care.

There were cribs available for each infant under 12 months old and/or mats available for infants over 1 year old. There are in-service plans for each infant in the infant classroom. The infant classroom has a changing table which is in reach of a sink and water access. First aid supplies were available.

There are adequate toys, equipment, and supplies available for the children. LPA inspected the outdoor play area and observed equipment to be in safe condition, with adequate cushioning material. Shaded areas are also available.

LPA observed all required forms to be posted. LPA reviewed the sign/in-sign/out sheet and reviewed children’s and staff's files.

*Continued on LIC 809-C
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Blake MorillasTELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2019
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: KINDERLAND PRESCHOOL INFANT CENTER
FACILITY NUMBER: 293617518
VISIT DATE: 07/08/2019
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
*Continuation of LIC 809

All staff currently employed with the facility have criminal record clearances, health screening reports with TB test, and Mandated Reporter training. At least one staff member present today has current Pediatric CPR and First Aid.

LPA provided and discussed the Safe Sleep in Child Care and Lead Testing brochures (AB 2370).

LPA provided the Licensing Agency website (www.ccld.ca.gov), so the Director may obtain updated licensing information, regulations, and forms.



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

In the areas that were evaluated, no deficiencies were cited during the visit.



Report was reviewed with the Administrator and an exit interview was conducted.

Notice of Site Visit posted.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Blake MorillasTELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2