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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 293617518
Report Date: 03/05/2020
Date Signed: 03/05/2020 12:46:34 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: 16DATE:
03/05/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Lupe Peterson - AdministratorTIME COMPLETED:
01:00 PM
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Please Note: All times noted in the report are an approximation.
On Thursday, March 5th, 2020, at approximately 11:21am, Licensing Program Analyst (LPA) Blake Morillas met with the Administrator, Lupe Peterson, for the purpose of an unannounced Annual Required inspection. At 11:16am, 16 infants and 5 staff in separate rooms were observed.

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.

At 11:34am, LPA initiated a health and safety inspection of all indoor areas accessible to children.

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. Menus were posted.

LPA reviewed care and supervision of children, staffing ratios, health related services (including medications and first aid supplies), furniture, equipment, and fire drills logs. LPA observed all required forms to be posted. Sign/in-sign/out sheet were reviewed. Drinking water is readily accessible to children in care. LPA observed sinks and toilets to be operable. There are adequate toys, equipment, and supplies available for the children.
At 11:46am, LPA inspected the outdoor play area and observed adequate cushioning material and play equipment to be in safe condition. Shaded areas are also available.

*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: 03/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2020
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: KINDERLAND PRESCHOOL INFANT CENTER
FACILITY NUMBER: 293617518
VISIT DATE: 03/05/2020
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*Continuation of LIC 809

At 11:54am, LPA began to review children’s and staff's files. All staff currently employed with the facility have criminal record clearances, health screening reports with TB test, immunizations, 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 (ccld.ca.gov), so the Administrator may obtain updated licensing information, regulations, and forms.

Incidental Medical Services (IMS) policy was discussed. 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 for TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the Americans with Disabilities Act, available at: http://www.ada.gov/childqanda.htm

In the areas that were evaluated, there were no deficiencies at this time.

At 12:38pm, LPA reviewed the report with the Administrator and an exit interview was conducted.

LPA provided a Notice of Site Visit and the Administrator acknowledges that this notice shall remain posted for 30 days for parental review.



The Administrator's signature on this form acknowledges receipt of this form.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Blake MorillasTELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2020
LIC809 (FAS) - (06/04)
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