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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343609927
Report Date: 04/28/2022
Date Signed: 04/28/2022 03:32:20 PM


Document Has Been Signed on 04/28/2022 03:32 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833



FACILITY NAME:HERMAN LEIMBACH ELEMENTARY SCHOOLFACILITY NUMBER:
343609927
ADMINISTRATOR:CORDOVA, ABELARDOFACILITY TYPE:
850
ADDRESS:8101 GRANDSTAFF DR.TELEPHONE:
(916) 689-2120
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY:48CENSUS: 26DATE:
04/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Carolyn HarveyTIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Gagandeep Singh met with facility representative, Carolyn Harvey, for an unannounced annual inspection. Purpose of the inspection was explained. This facility operates at school site in room F1 and G1. Upon LPA’s arrival, there were 26 children with four staff members. Facility is operating with in the capacity and in compliance with staff child ratio on this day.

During inspection, LPA inspected both of the classrooms and the play yard. There are no bodies of water at the facility. Facility has smoke detectors, carbon monoxide detector, fully charged fire extinguishers and working telephone at the site. All of the cleaning solutions, poisons and other chemicals that are dangerous to the children are stored inaccessible to the children. Facility has age appropriate furniture. Furniture is steady and in good repair. Facility has sufficient amount of sleeping matts. All toilets, hand washing facilities are in working condition with proper sanitation in place. Facility has drinking water available for children. The facility provides meal to the children. Food preparation area is free of litter. All of the food is stored adequately to prevent any contamination. Play yard is free of hazards. All of the play structures are steady, in good repair and free of any loose parts. There is sufficient amount of wood chips under the play structures to prevent any fall injuries. Facility has water fountain to provide drinking water to the children in play yard. There is plenty of shaded area in the play yard for the children.

LPA observed the facility has license, emergency disaster plan and all of other required documents posted in each classroom. LPA observed that facility sign in / out sheet at the entrance door. Facility has well maintained roster available on site. LPA reviewed eight random children's and all present staff's files. LPA observed facility has record of names, addresses and telephone numbers of each child's authorized representative. Multiple staff members have record of valid CPR card in file. LPA reviewed the educational qualification of all the teachers. LPA observed facility has fire drill log in place and per log, last drill was conducted on March 08, 2022.
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Gagandeep SinghTELEPHONE: (916) 216-7823
LICENSING EVALUATOR SIGNATURE:
DATE: 04/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/28/2022
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: HERMAN LEIMBACH ELEMENTARY SCHOOL
FACILITY NUMBER: 343609927
VISIT DATE: 04/28/2022
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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 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

LPA reminded the director that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. LPA observed the facility is using the Department approved training and has completion certificates on file.



LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. Licensee can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

No deficiencies are cited today. The copy of this report is reviewed and provided to the facility representative. Notice of site visit is posted and shall remain posted for next 30 days.
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Gagandeep SinghTELEPHONE: (916) 216-7823
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2022
LIC809 (FAS) - (06/04)
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