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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340310524
Report Date: 04/29/2022
Date Signed: 04/30/2022 08:30:52 PM

Document Has Been Signed on 04/30/2022 08:30 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:PACIFIC PRESCHOOLFACILITY NUMBER:
340310524
ADMINISTRATOR:PAYTON, RACQUELFACILITY TYPE:
850
ADDRESS:6201 41ST STREET, ROOM 23TELEPHONE:
(916) 395-5324
CITY:SACRAMENTOSTATE: CAZIP CODE:
95824
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 12DATE:
04/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Amy RonsheimerTIME COMPLETED:
03:00 PM
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On Friday, April 29, 2022 at 1:00 PM, Licensing Program Analysts (LPA) Amanda Sutter and Karyn Guerra met with Lead Teacher Amy Ronsheimer for the purpose of an unannounced required 1 year annual inspection. Upon arrival, LPA observed 12 preschool children supervised by 2 staff. The facility hours of operation are Monday through Thursday from 8:00 AM to 11:30 AM (AM session), and 12:00 PM to 3:00 PM (PM session). Friday hours are 12:00 PM to 3:00 PM. The facility does not offer transportation services.

LPAs toured classroom space, restrooms, and outdoor play area. LPAs observed the following documents are posted: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, menu, fire drill log, and daily schedule. Cleaning disinfectants, medications and hazardous items are appropriately stored and inaccessible to children. Director 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, and the floors appeared to be clean throughout the facility. The program provides lunch.



LPA observed trash bins with tight fitted lids. Drinking water is readily available to children both indoors and outdoors. Director stated that there is a water pitcher that is used and disposable cups are accessible to children. LPAs observed the facility’s paper sign in and out system. Facility has record of conducting fire drills at least every six months; last fire drill was conducted on 3/10/2022. Playground equipment and surfaces are free of loose or sharp parts. There are sufficient equipment and toys, and there are shaded areas supplied by two large trees.

Two staff and five children's records were reviewed. Both children and staff files were observed. Lead teacher stated that she had completed a CPR and First Aid training recently but documentation was not observed on file. LPA reminded lead teacher that 100% supervision is required at all times. LPAs observed a functional carbon monoxide detector, smoke detector and fire extinguisher. LPA reviewed the Department's inspection authority and discussed with designee any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within ten working days.
PAGE 1. REPORT CONTINUES ON LIC809-C
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Amanda Sutter
LICENSING EVALUATOR SIGNATURE: DATE: 04/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/29/2022
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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: PACIFIC PRESCHOOL
FACILITY NUMBER: 340310524
VISIT DATE: 04/29/2022
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LPAS discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPAS also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Service (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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

Licensee [or 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.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

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 Amy Ronsheimer.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Amanda Sutter
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2022
LIC809 (FAS) - (06/04)
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