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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340300156
Report Date: 10/18/2019
Date Signed: 10/18/2019 02:08:11 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:CORDOVA BAPTIST PRESCHOOLFACILITY NUMBER:
340300156
ADMINISTRATOR:HUPPERT, CARRIEFACILITY TYPE:
850
ADDRESS:10527 COLOMA ROADTELEPHONE:
(916) 638-5506
CITY:RANCHO CORDOVASTATE: CAZIP CODE:
95670
CAPACITY:87CENSUS: 33DATE:
10/18/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Carrie HuppertTIME COMPLETED:
02:20 PM
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Licensing Program Analyst (LPA), Jan Hoshida, conducted a Plan of Corrections (POC) inspection to clear deficiencies that were cited on 10/10/19. LPA met with Director, Carrie Huppert. Upon arrival, LPA observed 33 children supervised by four staff members.

Care and Supervision. No child(ren) shall be left without the supervision of a teacher at any time except as specified in sections 101216.2(e)(1) and 101230(c)(1). On 10/10/19, LPA observed children were not under direct supervision during the inspection.

During today's inspection, LPA observed that all children were under direct supervision. Director provided proof of staff training of supervision policies and stated that she has implemented a new supervision protocol to ensure that all children are under direct supervision at all times. LPA observed that Teachers escorted all children to the restroom area ensuring care and supervision as required by Title 22. POC cleared during today's inspection.

Carbon Monoxide detectors. Every licensed child day care center shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. On 10/10/19, LPA did not observe installed carbon monoxide detectors during the inspection.

During today's inspection, LPA observed that working Carbon Monoxide detector within the facility.

Exit interview was conducted, Appeal Rights were discussed and Notice of Site Visit was posted.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Jan HoshidaTELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2019
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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