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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343608842
Report Date: 10/10/2019
Date Signed: 10/10/2019 02:32:56 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:SOMETHING EXTRA PRESCHOOL & CHILDCAREFACILITY NUMBER:
343608842
ADMINISTRATOR:THROCKMORTON, JAMIEFACILITY TYPE:
830
ADDRESS:7916 AZTEC DR.TELEPHONE:
(916) 348-0712
CITY:ANTELOPESTATE: CAZIP CODE:
95843
CAPACITY:15CENSUS: 7DATE:
10/10/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Jamie ThrockmortonTIME COMPLETED:
03:00 PM
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This is an amended report. LPA Kelly met with Center's Licensing Manager, Amy Towne for the purpose of an annual inspection of the facility. LPA reviewed care and supervision of children, staffing ratios, health related services, including first aid supplies, furniture, equipment, fire drills, drinking water and food service provisions. There were 7 infants and 2 teachers present. Center provides lunch and pm snack for the children. The facility prepares the food.

LPA observed all required forms to be posted. There were cribs available for each infant under 12 months old. There are in-service plans for each infant in the infant classroom area. Infant area has changing tables which is in reached of a sink and water access. First aid supplies were available. There are adequate toys and equipment available for children. The restrooms were observed to be in working order. Director stated there are no children on medication.
LPA reviewed the sign/in-sign/out sheet. LPA reviewed children's emergency card. All staff currently employed with the Center have criminal record clearances and health screening. At least one staff member present today has current Pediatric CPR and First Aid.
LPA provided the Licensing Agency website (www.ccld.ca.gov), so the staff may obtain updated licensing information, regulations, and forms.

In the areas that were evaluated, no deficiencies were cited during inspection.
Exit interview was conducted. Notice of Site Visit posted.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Socorro KellyTELEPHONE: (916)216-7792
LICENSING EVALUATOR SIGNATURE:

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

DATE: 10/10/2019
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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