343604338-9-13-2021-53-CC-JBIK-C6U2KA-20210913172736

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343604338
Report Date: 09/13/2021
Date Signed: 09/13/2021 05:27:42 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:	PEACE PRESCHOOL		FACILITY NUMBER:	343604338
ADMINISTRATOR:	FORTES, KIMBERLY		FACILITY TYPE:	850
ADDRESS:	9145 FRANKLIN BLVD.		TELEPHONE:	(916) 684-2836
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95758
CAPACITY:	33	CENSUS:	DATE:	09/13/2021
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	03:15 PM
MET WITH:	Kimberly Fortes		TIME COMPLETED:	05:35 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

On 09/13/2021 at 3:15 PM Licensing Program Analysts (LPAs) Jeevun Birk-Miller and Aruna Sridharan met with Director, Kimberly Fortes for the purpose of an unannounced annual random inspection. Director was reminded never to exceed the conditions, limitations and capacity specified on the license. There were no children present as the program had ended for the day when the LPAs arrived. Facility hours of operation are Monday through Friday from 8:30 AM to 3:00 PM.

LPAs toured the building including all activity and classroom spaces, restrooms, food service, and outdoor play areas. Poisons are kept in a locked closet on premises. Toxic and hazardous items are inaccessible to children. Furniture and equipment are in good condition. Playground equipment and surfaces are free of loose or sharp parts. The floors appeared clean throughout the facility. The food preparation space is free of litter and all food was protected against contamination. LPAs observed that storage containers for solid waste and diaper disposal have tight-fitting covers. Program provides snack to each session of children. Menus were posted and drinking water was readily available to children both indoors and outdoors.

LPAs observed parents are signing in/out properly using the sign in and out sheets on clip boards. Four staff and nine children's records were reviewed. All staff and children's files had the required documents in them.

At least one staff member present today has current Pediatric CPR and First Aid certification (exp. 08/2022). Mandated Reporter training was observed and current for all staff. 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. LPA reminded the Director that 100% supervision is required at all times. Children do not nap during their hours at the facility as they are half day program.

Continue to 809-C page.

SUPERVISOR'S NAME: Jeanne Smith	TELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Jeevun Birk	TELEPHONE: (916) 917-6078
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2021

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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: PEACE PRESCHOOL	FACILITY NUMBER: 343604338
	VISIT DATE: 09/13/2021

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. LPA reviewed the Department's inspection authority and discussed with Director 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.

This facility provides Incidental Medical Services – IMS. 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 Center and the ADA, available at: http://www.ada.gov/childqanda.htm

LPA verified the annual fees are current.

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.

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/inspection-process.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director.

SUPERVISOR'S NAME: Jeanne Smith	TELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Jeevun Birk	TELEPHONE: (916) 917-6078
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2021

LIC809 (FAS) - (06/04)

Page: 2 of 2