313614186-8-3-2021-03-CC-ABLI-C5JRB6-20210803125214

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 313614186
Report Date: 08/03/2021
Date Signed: 08/03/2021 12:52:21 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:	HOLY CROSS LUTHERAN PRESCHOOL		FACILITY NUMBER:	313614186
ADMINISTRATOR:	WILLIAMS, OCTAVIA		FACILITY TYPE:	850
ADDRESS:	4701 GROVE STREET		TELEPHONE:	(916) 624-2123
CITY:	ROCKLIN	STATE: CA	ZIP CODE:	95677
CAPACITY:	126	CENSUS: 41	DATE:	08/03/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Octoavia Williams		TIME COMPLETED:	01:15 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

All times in this report are approximations. At 11:30am Licensing Program Analyst (LPA) Amanda Blesi and Office Technician Josiah Gathing arrived at the facility and met with Directror, Octavia Williams for the purpose of an unannounced required annual inspection. LPA toured the facility including all activity and classroom spaces, kitchen, restrooms, and outdoor play areas. Appropriate ratio and care and supervision were observed during today's inspection. Census included 33 preschool children and 8 school age children as part of the school age option. Director was reminded never to exceed the conditions, limitations and capacity specified on the license.

All classrooms appeared clean including the carpets and floor. Chemicals were kept inaccessible to children. Playground equipment and surfaces were inspected and are in good condition with enough resilient material under climbing structures to absorb a fall. Uncontaminated drinking water was readily available to children both indoors and outdoors. Bathrooms were clean and all sinks and toilets were in operating condition. There are no firearms or bodies of water on the premises and the facility has at least one functioning smoke and carbon monoxide detector. Menus were posted for AM and PM snack and the facility provides lunch or children bring their own. LPA observed all required licensing documentation was posted for parental review. LPA observed that parents are signing their children in and out of the center electronically.

A sample of children and staff files were reviewed. Each child's file contained emergency card the required licensing documentation and LPA advised the Director that the Immunization Cards should be updated to the new Public Health form. LPA verified that staff were qualified to work with preschool children. At least one staff had a current Pediatric CPR and First Aid certification that expires in October 2022.

Report is continued on the following...LIC 809-C

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Amanda Blesi	TELEPHONE: (916) 208-3427
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021

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: HOLY CROSS LUTHERAN PRESCHOOL	FACILITY NUMBER: 313614186
	VISIT DATE: 08/03/2021

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

Incidental Medical Services (IMS) policy was discussed. Each classroom was equipped with First Aid equipment. For additional IMS information, director was advised to 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.

LPA encouraged director to the visit the department's website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to child care centers. LPA discussed 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 1st, 2020 to January 1st, 2023 and must be conducted every five years from initial testing.

The facility evaluation report was reviewed and discussed with director. A notice of site visit was provided and should remain posted for a period of 30 days for parental review.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Amanda Blesi	TELEPHONE: (916) 208-3427
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021

LIC809 (FAS) - (06/04)

Page: 2 of 2