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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313622982
Report Date: 10/20/2021
Date Signed: 10/20/2021 03:08:39 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:SMART START CREATIVE LEARNING CTR (PS)FACILITY NUMBER:
313622982
ADMINISTRATOR:BAKER, BREANAFACILITY TYPE:
850
ADDRESS:7117 HOPE WAYTELEPHONE:
(916) 770-9548
CITY:PENRYNSTATE: CAZIP CODE:
95663
CAPACITY:45CENSUS: 24DATE:
10/20/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Breana Baker - DirectorTIME COMPLETED:
03:20 PM
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On Wednesday, October 20th, 2021, at 2:18pm, Licensing Program Analyst (LPA) Blake Morillas conducted a unannounced Case Management visit in regards to a received Unusual Incident Report (UIR). LPA informed the Director, Breana Baker, of the reason for the inspection. At 2:20pm, 24 preschool children and 3 staff, all outside on the play yard, were observed.

On October 4th, the Director self reported an incident that took place on 9-30-2021, where a child was running in the play yard, tripped and fell, sustaining injury.

At 2:22pm, the LPA toured the day care facility where the incident occurred and conducted interviews of the staff that were present at the time the incident occurred. After conducting interviews and making observations, it was determined that no Title 22 violations took place.

At 3:05pm, the report was reviewed with the Director and an exit interview was conducted.

Notice of site visit posted to be posted for the next 30 days.

SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Blake MorillasTELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2021
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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