313610656-1-3-2024-03-CC-LHAM-CZ5TAZ-20240103133423

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 313610656
Report Date: 01/03/2024
Date Signed: 01/03/2024 01:34:31 PM

Document Has Been Signed on 01/03/2024 01:34 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	PACIFIC OAKS PRESCHOOL		FACILITY NUMBER:	313610656
ADMINISTRATOR:	CLEMMER, PAULA		FACILITY TYPE:	850
ADDRESS:	4500 PACIFIC ST. #F		TELEPHONE:	(916) 630-1688
CITY:	ROCKLIN	STATE: CA	ZIP CODE:	95677
CAPACITY:	51	CENSUS: 1	DATE:	01/03/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	11:50 AM
MET WITH:	Paula Clemmer		TIME COMPLETED:	01:45 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 Wednesday January 4, 2024 Licensing Program Analyst (LPA) Lea Habtom met with Facility Representative Paula Clemmer for the purpose of an unannounced required annual inspection. LPA observed 1 child supervised by 3 staff and the director. The facility hours of operation are Monday through Friday from 8:30 AM through 11:30 AM.

LPA toured all classroom spaces, restroom, and outdoor play area. LPA observed the following documents are posted: License, Emergency Disaster Plan, Earthquake Preparedness, Personal Rights, Parents' Rights Poster and seat belt law. Cleaning disinfectants, medications and hazardous items are appropriately stored and inaccessible to children. Facility Representative stated there are no poisons or firearms on the premises. Furniture and equipment are in good condition, and toileting facilities are in safe, sanitary and operating condition. Parents provide snacks and the program has back up snacks.

LPA observed trash bins with tight fitted lids. Drinking water is readily available to children both indoors and outdoors with disposable cups and water coolers. The facility provides water bottles for outdoor use. LPA observed the facility’s electronic sign in & sign out. Facility has record of conducting fire drills at least every six months; last fire drill was conducted November 16, 2023. Playground equipment and surfaces are free of loose or sharp parts. There is sufficient equipment and toys, and there are shaded areas supplied by shade structures.

Three staff and five children's records were reviewed. Both children and staff files were observed to be complete. There is at least one staff member present with a current CPR certificate. LPA observed a functional carbon monoxide detector.

PAGE 1. REPORT CONTINUES ON LIC809-C

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Lea Habtom	TELEPHONE: (916) 208-2538
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024

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 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: PACIFIC OAKS PRESCHOOL	FACILITY NUMBER: 313610656
	VISIT DATE: 01/03/2024

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

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For childcare center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/.

Facility Representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

PAGE 2. REPORT CONTINUES ON LIC809-C

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Lea Habtom	TELEPHONE: (916) 208-2538
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: PACIFIC OAKS PRESCHOOL	FACILITY NUMBER: 313610656
	VISIT DATE: 01/03/2024

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

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

LPA confirmed that the annual fees are current. LPA informed the Director of the recent regional office relocation and provided updated personal and parent's rights forms and postings.

Facility Representative was informed of the www.mychildcareplan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

During today’s inspection no deficiencies were observed. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Facility Representative Paula Clemmer.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Lea Habtom	TELEPHONE: (916) 208-2538
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024

LIC809 (FAS) - (06/04)

Page: 3 of 3