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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343608969
Report Date: 02/08/2023
Date Signed: 02/08/2023 11:22:39 AM


Document Has Been Signed on 02/08/2023 11:22 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:RALPH RICHARDSON PRESCHOOLFACILITY NUMBER:
343608969
ADMINISTRATOR:LESSARD, NOELFACILITY TYPE:
850
ADDRESS:4848 COTTAGE WAYTELEPHONE:
(916) 971-7411
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:72CENSUS: 14DATE:
02/08/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Lara KhanTIME COMPLETED:
11:30 AM
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On Wednesday, February 8, 2023, at approximately 10:00 AM, Licensing Program Analyst (LPA) Josiah Gathing met with Site Supervisor, Lara Khan, for the purpose of an unannounced annual random inspection. Classroom #1 is not currently in use. Classroom #2 is a Head Start class operating from 8:00 AM to 2:30 PM with a minimum day on Thursdays from 8:00 AM to 11:45 AM. Classroom #3 is a Wrap program operating from 8:00 AM to 2:30 PM, with a minimum day on Thursdays from 8:00 AM to 11:45 AM. LPA observed a census of 14 children supervised by 3 staff and 1 aide in Room 3, and 17 children supervised by 3 staff and 1 aide in Room 2.

Criminal record clearance is on file with San Juan Unified School District. Site Supervisor 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.



A health and safety inspection was conducted in the classrooms, restrooms, food service areas, and outdoor play areas. LPA observed the following documents are posted: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, menus, and daily schedule. Cleaning disinfectants and hazardous items are appropriately stored and inaccessible to children. Furniture and equipment are in good condition, and toileting facilities are in safe, sanitary, and operating condition. Bins for solid waste have tight fitting lids. The floors appeared clean throughout the facility. Breakfast and lunch are prepared in the school cafeteria.

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.

Report continues on 809-C...

SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Josiah GathingTELEPHONE: (916) 799-9668
LICENSING EVALUATOR SIGNATURE:
DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/08/2023
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: RALPH RICHARDSON PRESCHOOL
FACILITY NUMBER: 343608969
VISIT DATE: 02/08/2023
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There are functional water fountains indoors and outdoors. LPA observed full legal signatures while reviewing the sign in and sign out sheets. Playground equipment and surfaces are free of loose or sharp parts. LPA observed wood chip cushioning beneath the play structure. Outdoor shade is provided by canopies. Facility representatives informed LPA that the playground floods during rain, but there was no standing water at the time of today's inspection. There are no firearms or bodies of water on the premises. LPA observed a Carbon monoxide detector in room #3.

LPA reviewed staff and children's records. Each child's file contained an admission agreement, emergency card, health history, immunization record, and acknowledgement of receipt for personal rights, consent for emergency medical treatment, and parent’s rights. LPA observed current EMSA approved CPR and First aid certification for staff on the facility premises. LPA observed health screening, staff immunization records and current AB 1207 Mandated Reporter training certificates. LPA observed employee rights, and documentation of the educational background, training, and/or experience.

LPA verified that annual fees are current.

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.

In the areas that were evaluated, no deficiencies were cited during today’s inspection. Exit interview conducted and report was reviewed with the Site Supervisor, Lara Khan. A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Josiah GathingTELEPHONE: (916) 799-9668
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023
LIC809 (FAS) - (06/04)
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