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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313620674
Report Date: 08/20/2024
Date Signed: 08/21/2024 08:47:40 AM


Document Has Been Signed on 08/21/2024 08:47 AM - 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:CARLIN C. COPPIN ELEMENTARY PSFACILITY NUMBER:
313620674
ADMINISTRATOR:QUINN, LAREEFACILITY TYPE:
850
ADDRESS:150 EAST 12TH STREETTELEPHONE:
(530) 745-1380
CITY:LINCOLNSTATE: CAZIP CODE:
95648
CAPACITY:24CENSUS: 0DATE:
08/20/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Natallia ZagoruikoTIME COMPLETED:
04:15 PM
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On August 20, 2024, Licensing Program Analyst (LPA) Lea Habtom arrived to the Carlin C. Coppin Elementary school campus and checked in with the front office. LPA met with site supervisor Nataliia Zagoruiko for the required 1 year annual inspection. There were no children present at the time of the inspection. The facility is located on Carlin C. Coppin Elementary school campus. All criminal record clearances are associated to this facility at Sierra College Rocklin State Preschool #313606938. Facility hours of operation are Monday through Friday from 12:00 pm- 3:00 pm.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA toured the classroom, restroom, and outdoor play area. Staff stated there are no children who require medication. Toxic and hazardous items are inaccessible to children. Paper sign-in & sign-out sheets were observed with full signatures. Furniture and equipment are in good condition. Playground equipment and surfaces are free of loose or sharp parts. Sand and Wood chips are being used as cushioning around the climbing equipment and level is sufficient to absorb a fall. The program shares the transitional kindergarten and head start playground on the school campus. Toilets and faucets are in safe and operable conditions. The floors appeared clean throughout the facility. All food was protected against contamination. PM snack is provided by the program and no lunch is served. Children do not take naps as the program operates for 3 hours in one session. Drinking water was readily available to children both indoors and outdoors. There are no firearms or bodies of water on the premises. LPA observed a functional carbon monoxide detector. Two staff and four children's records were reviewed. At least one staff member present today has current Pediatric CPR and First Aid certification. LPA reviewed the Department's inspection authority and discussed any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

Report continued on 809-C.

SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Lea HabtomTELEPHONE: (916) 208-2538
LICENSING EVALUATOR SIGNATURE:
DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/20/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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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: CARLIN C. COPPIN ELEMENTARY PS
FACILITY NUMBER: 313620674
VISIT DATE: 08/20/2024
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No children are on medication. 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 Evaluator Manual-Regulation Interpretations and Procedures for Child Care Center Sections 101173 and 101226. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 513-0301 (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.ht

Staff are encouraged to the visit the Department's website at WWW.CDSS.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining child care centers.

This report was reviewed with site supervisor Nataliia Zagoruiko. Appeal rights and a notice of site visit provided. There were no Title 22 Deficiencies cited during today's inspection.

SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Lea HabtomTELEPHONE: (916) 208-2538
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024
LIC809 (FAS) - (06/04)
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