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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340319008
Report Date: 09/09/2022
Date Signed: 09/09/2022 11:38:21 AM


Document Has Been Signed on 09/09/2022 11:38 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833



FACILITY NAME:WOODLAKE STATE PRESCHOOL PORTABLEFACILITY NUMBER:
340319008
ADMINISTRATOR:FLORES-ACOSTA, REBECCAFACILITY TYPE:
850
ADDRESS:700 SOUTHGATE ROADTELEPHONE:
(916) 566-2755
CITY:SACRAMENTOSTATE: CAZIP CODE:
95815
CAPACITY:24CENSUS: 11DATE:
09/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Rebecca Flores-AcostaTIME COMPLETED:
11:45 AM
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On September 9, 2022, at approximately 10:05 AM, Licensing Program Analyst (LPA) Alize Tillery met with Director Rebecca Flores-Acosta for the purpose of an unannounced required 1 year annual inspection. At approximately 10:30 AM, ECE Program Specialist, Nicole Schlie, arrived to assist LPA for the remaining of the inspection. Upon arrival, LPA observed 11 preschool children supervised by 2 staff. The facility hours of operation are Monday through Friday from 8:00 AM to 11:00AM and 12:00 PM to 3:00 PM. The program does not offer napping services, as it operates in two separate half days. The facility does not offer transportation services.

LPA toured all activity and classroom spaces (Room #8), restrooms and outdoor play areas. LPA observed the following documents are posted: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, menu and daily schedule. Cleaning disinfectants and hazardous items are appropriately stored and inaccessible to children. Director stated there are no medications, 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. LPA observed a functional carbon monoxide detector, smoke detector and fire extinguisher.



The program provides one meal for each half day class (breakfast and lunch). LPA observed trash bins with tight fitted lids. Drinking water is readily available to children both indoors and outdoors. Director stated that they use paper cups and their filtered water jug. LPA observed the facility’s electronic sign in and out system. Facility has does not have record of conducting fire drills at least every six months; Director stated that the facility was closed for the summer and program just reopened on 8/18/2022. Director stated that a fire drill is scheduled for 9/29/22. Playground equipment and surfaces are free of loose or sharp parts. There are sufficient equipment and toys, and there are shaded areas supplied by trees, and there are wood chips under the play structure for cushioning.
Report continues on 809-C.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Alize TilleryTELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:
DATE: 09/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/09/2022
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: WOODLAKE STATE PRESCHOOL PORTABLE
FACILITY NUMBER: 340319008
VISIT DATE: 09/09/2022
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2 staff and 6 children records were reviewed. Staff files were observed to be complete and included: Education Verification, LIC 501 Personnel Record, LIC 503 Health Screenings, LIC 508 Criminal Record Statements, LIC 9052 Employee Rights, Immunizations (Tdap, MMR, Influenza) and current Mandated Reporter training certificates. At least one staff member present today has a current Pediatric CPR and First Aid certification that expires in 05/26/2023.

Children Files were also observed to be complete and included: Admission Agreements, Physician and Parent Health History Reports, Emergency Cards, Consent for Medical Treatment forms, Personal and Parent Rights Forms, and immunizations. LPA observed a current Children’s Roster. LPA reminded Licensees that 100% supervision is required at all times. 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.

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.


Incidental Medical Services (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 is 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



Director 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.

During today’s inspection, no deficiencies were observed.
A notice of site visit was given and must remain posted for 30 days. An exit interview was conducted and the report was reviewed with the Director Rebecca Flores-Acosta and ECE Program Specialist Nicole Schlie.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Alize TilleryTELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2022
LIC809 (FAS) - (06/04)
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