343602581-3-3-2023-03-CC-MPAL-CPKUAA-20230303142425

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343602581
Report Date: 03/03/2023
Date Signed: 03/03/2023 02:24:44 PM

Document Has Been Signed on 03/03/2023 02:24 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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME:	ANTELOPE CHRISTIAN ACADEMY PRESCHOOL		FACILITY NUMBER:	343602581
ADMINISTRATOR:	CAROLYN HEWETT		FACILITY TYPE:	850
ADDRESS:	4533 ANTELOPE ROAD		TELEPHONE:	(916) 722-6169
CITY:	ANTELOPE	STATE: CA	ZIP CODE:	95843
CAPACITY:	90	CENSUS: 26	DATE:	03/03/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:10 AM
MET WITH:	Carolyn Hewett		TIME COMPLETED:	01:45 PM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

Licensing Program Analysts (LPAs) Michelle Pascual and Erwina Pascual-Golamco met with Facility Representative Carolyn Hewett for an unannounced annual random inspection. Upon arrival, LPAs observed 26 children. Facility hours of operation are Monday through Friday (6 AM to 6 PM). Facility Representative was reminded never to exceed the conditions, limitations and capacity specified on the license. LPAs provided a Technical Advisory which ensures ratios must remain 1:12 in each classroom unless a secondary teacher is present.

LPAs toured all activity and classroom spaces, restrooms, and outdoor play areas. No medications were observed. Facility Representative stated there are no poisons on the premises. LPAs observed disinfectants and hand sanitizers stored at the bottom of the shelf that was not locked, making accessible to children. Furniture and equipment are in good condition. Playground equipment and surfaces are free of loose or sharp parts. The areas around or under climbing equipment are cushioned with bark to absorb the fall, except for under the slide. Toileting facilities are in safe, sanitary, and operating condition. The floors appeared clean throughout the facility. Facility does not provided food, as children bring it from home. Storage containers with solid waste have tight-fitting covers. Drinking water is readily available to children both indoors and outdoors. LPAs observed sign-in and sign-outs with legal signatures.

Three staff and 10 children's records were reviewed. Each child's file contained an emergency card. At least one staff member present today has current Pediatric CPR and First Aid certification expiring March 1, 2023 and is in the process of renewal. All staff currently employed with the facility have a criminal record clearance, health screening report, and documentation of the educational background, training, and/or experience. Mandated Reporter for staff expires July 2024.

SUPERVISOR'S NAME: Natalie Dunaway	TELEPHONE: (916) 584-3508
LICENSING EVALUATOR NAME: Michelle Pascual	TELEPHONE: (916) 594-3812
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: ANTELOPE CHRISTIAN ACADEMY PRESCHOOL	FACILITY NUMBER: 343602581
	VISIT DATE: 03/03/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

There are no firearms or bodies of water on the premises. LPAs observed a functional carbon monoxide detector. LPAs reviewed the Department's inspection authority and discussed with Facility Representative 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.

Incidental Medical Services (IMS) are not being offered. 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 Centers Sections 101173 and 101226.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

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.

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.

Facility Representative was encouraged to the visit the departments website at WWW.CDSS.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining child care centers.

SUPERVISOR'S NAME: Natalie Dunaway	TELEPHONE: (916) 584-3508
LICENSING EVALUATOR NAME: Michelle Pascual	TELEPHONE: (916) 594-3812
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2023

LIC809 (FAS) - (06/04)

Page: 2 of 2